The Origins of the Treatment of Traumatic Spinal Injuries

Abstract

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.