Primary Care and Laboratory Medicine

testing the recovery of cutaneous sensation after Head had two superficial nerves cut and resutured, taking care that Head had had adequate sleep the previous night, could not see the stimulus being applied, and did not become fatigued during the procedures, limited to 2 hours in the morning and in the evening. The observations resulted in the concept of diffuse (protopathic) and precise (epicritic) sensation, published in a mammoth joint paper in Brain. Rivers founded and headed experimental psychology departments simultaneously at Cambridge and at University College, London. At Cambridge he taught medical and other science undergraduates, and regarded becoming acquainted with students as mandatory: his Sunday morning breakfasts and Sunday evenings 'At Home' became famous. Undergraduates could visit him at most hours of the day, except between 10 am and 1 pm when he was writing (like Descartes, Rivers rarely worked for more than 4 hours a day). Students were treated as equals, given tea, and encouraged to criticize: 'When students no longer contradict me flatly to my face, I shall know I have grown old.' A marked stammer afflicted Rivers, which he partly overcame by advice from his father (which he relayed to others including Lewis Carroll) forget it. Rivers noted that Carroll did not stammer when reading aloud: stammering also disappears when singing a method of treatment. Rivers' lecturing ability started poorly but with effort and practice he attained a high and always stimulating quality. Fatigue was Rivers' topic for his Croonian lectures to the Royal College of Physicians, London. His subjects had to eat and sleep the same amount for a week before they were tested; precautions were taken so that the experimenter did not influence those tested; neither knew whether the inert or active substance had been given-probably the first double-blind trial, a century ago. He concluded that caffeine and alcohol each had a dual action initial stimulation followed by depression of strength. How many psychologists take such care, or even are aware that lack of food or sleep can influence their observations? Neurology and psychiatry were not separated at the beginning of the century; for example Henry Head treated Virginia Woolf's depression which caused her tension headaches (not migraine as has been suggested). Rivers became a psychiatrist to the Army at the beginning of World War I, well portrayed in the novel Regeneration. Public opinion held that any soldier leaving the front line was a coward and a disgrace; psychiatrists recognized diverse psychological responses to stress, fatigue and immobility in cold, wet trenches. But attribution to organic injury from high-explosive blast made the condition an acceptable illness. Hence 'the unfortunate and misleading term "shell-shock" which the general public have now come to use for the nervous disturbances of warfare' (Rivers). He treated patients with kindness and deep understanding deriving from his own difficulties, encouraging them to talk about their experiences and nightmares which enabled Sassoon, Owen and others to return to duty. Rivers' treatment and thinking is more fully described in his Conflict and Dream. Unfortunately, this book is marked 'lost' in the Royal Society of Medicine's catalogue: if any one is prepared to loan me a copy, I promise to return it; or better donate a copy to the RSM library. After the war Rivers became increasingly committed to anthropology, dealt with in extenso by Slobodin-not of absorbing interest to me or, I imagine, many JRSM readers. But I am left wondering what Rivers would have thought of chronic fatigue syndrome? Or Gilles de la Tourette syndrome, having treated patients at Craiglockhart Military Hospital which was 'a museum of twitches and grunts'. We shall never know. But having read his writings, I know I have been in the presence of a great man.