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Study design: Literature review. Setting: Europe with special reference to France. Objectives: To review the treatment of spinal deformity in nineteenth century Europe and explain the high incidence of paralysis as a result of forceful traction of the spinal column to treat scoliosis in France as compared with other European countries. Conclusion: Although well described in the nineteenth century French medical literature, the dangers of forceful traction on the spinal column to correct spinal deformity were not recognized in Europe or the USA until the halofemoral traction method of treatment was used in the 1970s.

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.

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.

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.