George Riddoch and Ludwig Guttmann: Wartime correspondence 1940-1947.

Recently discovered primary sources in the form of letters, memoranda and private communications between George Riddoch and Ludwig Guttmann provide much information on the setting up of spinal units in the United Kingdom during the Second World War. The two men developed a close relationship and in Guttmann, Riddoch found a man who had the knowledge, the ability and the energy to implement this shared vision.

The doctor as an artist.

Charles Bell, Francis Seymour Haden, Jean-Martin Charcot, Paul Richer, Henry Tonks and Harry Lamb were gifted draughtsmen. Some used their skills to illustrate their work, a few abandoned medicine altogether to become artists in their own right. With the exception of Haden few were able to combine an artistic and a medical career. Their medical training and their wartime experiences influenced their artistic portrayal of the wounded. Their significant contribution, however, resides in the way in which they influenced other greater artists through their teaching.

Merlin's 'invalid or gouty chair' and the origin of the self-propelled wheelchair.

Wheelchairs are a major advance in enabling independence for people with walking difficulties. The first self-propelled wheelchair has been attributed to John Joseph Merlin, the 'ingenious mechanick', in the early 19th century and his 'gouty chair' is exhibited at Kenwood House. Research would suggest that comparable chairs existed in France as early as 1751 and the French Revolutionary, Georges Couthon, used one to get around Paris. A later design, also attributed to Merlin, the invalid wheelchair, features large wheels with outer hoops for the occupant to grasp and this is the true ancestor of the modern wheelchair.

Nerve-stretching in the 19th century.

Operative nerve-stretching was first described in 1872 to relieve incurable pain from sciatica and tabes dorsalis. It became popular for 20 years and numerous articles were published on the subject. It had many complications but relief was only transient and, consequently, it fell into disuse. This paper analyses the literature, contemporary views on the benefits of nerve stretching and its influence on more recent neurological practice.

The origins of the treatment of traumatic spinal injuries.

BACKGROUND: It is widely acknowledged that Donald Munro in the United States (1936) and Ludwig Guttmann in the United Kingdom (1944) are the founders of the modern treatment of spinal injuries. However, Germany was the birthplace of neuropathology and led the field in neurology and psychiatry. The first effective spinal injury units were established by Wilhelm Wagner in Königshütte, Silesia and Emil Kocher in Bern, Switzerland at the end of the 19th century. SUMMARY: The modern principles of spinal injury treatment emanated from the work carried out by Wagner and Kocher. This knowledge was applied during the First World War in Germany, France, Austria, Switzerland and the United Kingdom. Marburg established a unit in Vienna, Dr. and Mrs. Déjerine and their team of French doctors treated casualties from the First World War and, in the United Kingdom, Gordon Holmes, George Riddoch and Henry Head treated soldiers suffering from spinal injuries in specialised units. After the war these units closed down, doctors went back to their previous occupations and the expertise gained was lost or, in the case of Germany, suppressed. It was only in 1939 when Ludwig Guttmann, a Jewish refugee, arrived in the United Kingdom that this specialised knowledge was used to set up satisfactory treatment. KEY MESSAGES: Many of the key principles of treatment for spinal injuries were developed at the end of the 19th century and during the First World War but units closed down and the knowledge gained was forgotten. With the advent of the Second World War, German refugees, many of whom had worked in the field of neurology (including Ludwig Guttmann), came to the United Kingdom armed with a thorough training in neurology and rehabilitation and applied these principles to the treatment of spinal injuries for the benefit of the country which gave them refuge.

Historical review: suspension therapy for the treatment of tabes dorsalis.

BACKGROUND: Suspension therapy was developed by a Russian doctor, A. Motschutkovsky and at the end of the 19th century it was a popular treatment for tabes dorsalis. It was endorsed by Jean-Martin Charcot in France and Weir Mitchell in the United States; but after 10 years, it was abandoned because it proved to be useless and some patients developed paralysis. SUMMARY: The effect of suspension upon a spinal cord affected by tabes dorsalis and a healthy spinal cord has been analyzed in the light of current knowledge. The benefits of suspension were thought to be due to an improvement in the blood supply to the spinal cord and due to the suggestibility or the placebo effect. Key Message: Analysis of the contemporary literature in the light of current research shows that suspension therapy was a powerful weapon that could cause impairment to the conductivity of the spinal cord and this has important implications for current therapy such as the use of Harrington rods.

The role of Edward Harrison's (1766-1838) disciples, Thomas Engall, John and George Epps, Charles Hoyland, John Evans Riadore, John Robinson and John Baptiste de Serney in the treatment of spinal deformity in the Victorian medical world.

Edward Harrison was a distinguished and innovative physician, an educationalist who had a profound influence on the treatment of spinal deformities. He founded the first infirmary for the treatment of spinal diseases in London in 1837. Little is known of this institution but much of Harrison's legacy rests with his disciples who followed Harrison's principles of treatment to treat spinal deformity. Like Harrison they were unconventional individuals, influenced by religious beliefs and liberal political and social ideologies. After his death, initially they followed his methods of treatment but subsequently they were not afraid to pursue new forms of treatment including homeopathy at a time when traditional medicine had little to offer.