D • Gunshot Injuries and Stab Wounds
CHAPTER 13
GUNSHOT INJURIES OF THE SPINAL CORD
Gunshot injuries of the spinal cord are amongst the most dangerous of injuries, the more
so as they are so frequently associated with penetrating injuries to other vital organs of the
body, the immediate surgical treatment of which often demands priority. This applies
in particular to the associate injuries of the chest and abdomen.
There are numerous excellent publications on pathophysiology and pathology of this
topic from the First World War (Holmes, 1915; Souques & Megevant, 1916; Eiselsberg
1916; Collier, 1917; Head & Riddoch, 1917-18; Marburg, 1917; Mingazzini, 1917;
Marinesco, 1917; Roussy & L'Hermitte, 1918; Thorburn, 1922; Cushing, 1927; Foerster,
1929). Foerster's experience is based on 395 cases (71 per cent gunshot injuries) and he
has given a comprehensive survey of the pathological changes of the spinal cord occurring
in complete and incomplete lesions as a result of the various types of gunshot injuries.
However, the results of both the conservative and surgical treatment obtained during the
First World War and the post-war period reveal a picture of profound hopelessness.
Cushing (1927), the leading neurosurgeon of the American Army in that period, very
aptly summed up the generally accepted views of the high mortality rate and sad prog
nosis of these injured as follows: Only patients with partial cord lesions survived.
The mortality rate of his own cases was 71-8 per cent, that of the operated cases 62-2 per
cent. In the British Army the results were not much better, varying between 47 and 65
per cent (Vellacott & Webb-Johnson, 1919), and according to Thompson-Walter (1927)
the mortality rate within 3 years was 80 per cent.
Even in the early periods of the Second World War the prognosis of gunshot injuries
of the spinal cord was considered very unfavourable and many physicians and surgeons
still adhered to the traditional defeatist attitude towards these unfortunate victims of
war. However, in further course of the war a fundamental change at least in the early
mortality rate of these patients, took place. This was due to: i, the great advance in the
treatment of traumatic shock in the front-line, in particular as a result of plasma and full
blood transfusions; 2, the presence of neurosurgical teams with their special equipment
to deal with emergency operations; 3, the introduction of sulfonamides and later penicillin
to combat wound infection and also infection of the paralysed bladder; 4, the very early
transfer of the wounded from the front to field and evacuation hospitals as well as hos
pitals at home (greatly helped later by air-transport); 5, last but by no means least the
early admission of many patients to Spinal Injuries Centres first set up in various parts
of Great Britain.
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