A Introduction
CHAPTER 1
HISTORICAL BACKGROUND
Of the many forms of disability which can beset mankind, a severe injury or disease of
the spinal cord undoubtedly constitutes one of the most devastating calamities in human
life. This is readily understood if one realizes the paramount physiological importance
of the spinal cord not only as the main transmitter of all impulses and messages from the
brain to all parts of the body and vice versa but also as a nerve centre in its own right,
controlling vital functions such as voluntary movements, posture, bladder, bowel, and
sexual functions, as well as respiration, heat regulation, and blood circulation. Therefore,
a severance or severe injury of the spinal cord, whether caused by trauma or disease,
always results in a disablement of great magnitude from the site of the lesion downwards.
It is obvious that such an affliction has always aroused medical interest, and references
to spinal cord injuries have already been found in records from very early periods of
civilization. The Edwin Smith Surgical Papyrus, written about 5,000 years ago by an
Egyptian physician (translated by the famous Egyptologist, Dr Breasted), contains a
clear description of the cardinal symptoms of a complete lesion of the cervical cord,
following dislocation or fracture of the spine: paralysis of all four extremities, complete
sensory loss, loss of bladder control, priapism, and involuntary seminal ejaculations.
Reference is even made to conjunctival congestion today recognized as the result of
vasodilatation due to paralysis of the vasomotor control in these high lesions. In discussing
the prognosis and therapy of such patients (cases 31 and 33 of the Papyrus), the comment
of the unknown author is as brief as it is significant: 'an ailment not to be treated'.
It is not known whether this ancient author has generalized his defeatist attitude to
spinal cord lesions at any level, but it cannot be denied that the sentiments thus expressed
have prevailed throughout thousands of years amongst most members of the medical
profession in all countries, towards sufferers from severe lesions of the spinal cord.
Medical history is very sketchy between the Egyptian and Greek periods. Homer
made reference in the tenth chapter of the
Odyssey
to Elpenor, the youngest of Odysseus's
companions, who, having got drunk and longing for fresh air, slept on the roof of Circe's
house. Roused in the morning by the bustle of his companions' departure, he leapt up
suddenly and, forgetting the right way down, toppled headlong from the roof, breaking
his neck, 'and his soul went down to Hades'.
Hippocrates, about 400 BC, in the chapter
nepl r&v evrocr TTOL$&V
describing chronic
paraplegia, mentions constipation and dysuria, as well as oedema of the lower limbs and
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