PREFACE
In 1950, I wrote a monograph on my experience on 570 spinal paraplegics and tetra–
plegics, of whom 458 were traumatic lesions, mainly war casualties, treated at the
National Spinal Injuries Centre, Stoke Mandeville Hospital in Aylesbury, since its
inception on i February 1944. This monograph, published in 1953 m Volume Surgery
of the British Medical History of the Second World War, laid down the principles of a
synthesis between all clinical procedures and measures of social and professional rehabili–
tation in a subject which, throughout all ages, had been considered as one of the most
depressing and neglected in medicine: Spinal Paraplegia.
The idea of giving spinal cord sufferers a comprehensive treatment and care from the
start and throughout all stages is now more and more universally recognized, as against
the customary approach of fragmentation of the initial and early treatment of these
patients from their social rehabilitation, erroneously called 'Third Phase5 ofmanagement.
In this respect, the congregation of paraplegics and tetraplegics in Spinal Centres under
the care of a specialized staff has proved beyond all doubt to be the best basis for such
comprehensive management of these most severely disabled victims of accidents and
disease, and consequently the idea of setting up of Spinal Injuries Centres, originated
during World War II in Great Britain, is now spreading all over the world.
New and significant disclosures have been made in our research throughout the
many years since that monograph was published, which were applied in the practical
management of the spinal man, and the consequence was a steady stream of publications
by myself and my co-workers on numerous aspects of that complex multidisciplinary
speciality of medicine, surgery and social science.
One can point to progress in many directions, but some of the more outstanding may
be mentioned here: the participation of the isolated cord through co-ordinated reflexes
in the restoration and maintenance of the upright position of the paralysed, reorientation
of postural and vasomotor control by special methods, prevention and treatment of
pressure sores and infection of the urinary tract in the immediate and later stages,
restoration of the respiratory function in tetraplegics and a new approach to the sexual
problems. Our findings of the highly significant role played by autonomic mechanisms,
especially the cardio-vascular system, in the function of the organism below and above
the transection of the spinal cord have opened new vistas into future research. Ways
have been revealed in which the dysfunction of internal organs in the paralysed part of
the body excite abnormal discharge of the various components of the autonomic system
and also how the autonomic hyperreflexia can be controlled and avoided. In the psycho-
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