title: Typhoid spine: somatic versus psychosomatic diagnosis in Osler's time.
abstract: OBJECTIVE
  To review the history of typhoidal spondylitis as a paradigm of conflicts between medical and psychiatric diagnoses.
  
  
  METHODS
  Because William Osler was the principal advocate for a psychogenic cause of this disease, all of his relevant writings are reviewed together with pertinent psychiatric concepts of the late 19th century, as well as the relevant bacteriologic and clinical research.
  
  
  RESULTS
  Bacteriologic research had advanced sufficiently by 1903 that "typhoid spine" could be proved an osteomyelitis. Nevertheless, the belief that at least some cases were manifestations of a traumatic neurosis analogous to "railway spine" persisted, the trauma having been the acute typhoid infection. The last vestiges of this concept were represented by Osler's article of 1919.
  
  
  CONCLUSIONS
  Osler's 25 year struggle to understand typhoidal spondylitis is an example of the persistent tendency of physicians to attribute a psychologic cause to a syndrome, often pejoratively, because of the absence of a sufficient pathophysiologic explanation or reluctance to acknowledge a new concept.
authors.affiliation: Department of Medicine, University of Pittsburgh School of Medicine, PA, USA.
authors.forename: T G
authors.initials: TG
authors.lastname: Benedek
mesh_terms: D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D011602:Psychophysiologic Disorders / Q000266:history*; D013166:Spondylitis / Q000266:history* / Q000382:microbiology / Q000523:psychology; D014435:Typhoid Fever / Q000266:history* / Q000523:psychology