Born in Silesia in 1899, Ludwig Guttmann worked as a medical orderly at the accident hospital for coal miners in Konigshütte where Wagner had treated spinal injury patients 20 years previously. After the First World War, he trained as a doctor and qualified in 1923. He worked in Breslau under Otfrid Foerster who had a major influence on his future approach and philosophy towards spinal injury treatment. Foerster, who was a master in rehabilitation and the first neurosurgeon in Europe, was described as a doctor who could make the blind see and the lame walk.2 Guttmann received a thorough training in neurology, neurosurgery and in rehabilitation of peripheral nerve injuries as Foerster treated over 4000 such cases.3 When the Nazis came to power, Guttmann lost his position as Foerster’s assistant and worked for 5 years at the Jewish hospital in Breslau. In 1939, he escaped to England but could not practice clinical medicine for 5 years as his qualification was not recognised. He worked in the Department of Surgery under Professor Hugh Cairns, carrying out research on peripheral nerve injuries but was extremely frustrated and considered leaving to enter general practice. His unique knowledge of rehabilitation of peripheral nerve injuries was recognised and he gave a lecture on the subject in the distinguished company of Geoffrey Jefferson at the Royal Society of Medicine, which was published in 1941.3 Guttmann was curiously reticent about this paper, although his ideas on peripheral nerve rehabilitation were subsequently incorporated into spinal cord rehabilitation.

As Hitler’s aggression spread across Europe, a resumption of hostilities was inevitable. Unlike the First World War, when casualties had all been servicemen, many civilian casualties were anticipated because of bombing. In 1939, Riddoch was appointed consultant neurologist to the army with the rank of Brigadier. He was chairman of the MRC committee on peripheral nerve injury, with responsibility for setting up spinal injury units. On the eve of the Second World War, only three British doctors had any experience of treating spinal injury cases; George Riddoch who was Resident Medical Officer in charge of a spinal unit at the Empire Hospital during the First World War, and Gordon Holmes and Henry Head who had both treated cases during the First World War. The Staff were not appropriately trained; physiotherapy was not yet fully established so exercise was not being used to rehabilitate patients. Occupational therapy was in its infancy as a profession with an ill-defined role; 'any activity, mental or physical... hastening recovery from disease or injury'.4

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