4
CHAPTER 1
even in 1917, when, before taking up medicine, I worked as an orderly in the Accident
Hospital for Coalminers (Knappschaftslazarett) in my home town of Konigshiitte in
Upper Silesia, Germany, now Chorzow, Poland. It was executed by the surgeon in
charge, Dr Hartmann, in a case of fracture-dislocation of the thoraco-lumbar junction of
the spine. The only difference between his and Pare-Calot's technique was that the patient
was held in the air in supine position by two assistants extending the patient under the
armpits and two extending the pelvis and legs, while the surgeon reduced the dislocation
by forceful manipulation with his fists from below. After this procedure, the patient
was put in a plaster cast. He died four weeks later from sepsis and cachexy as a result of
urinary infection and multiple pressure sores.
Surgical intervention in spinal injuries and operations on the spinal cord have been
discussed and described long before the modern principles of asepsis were discovered.
Amongst authors of ancient times, Galen, 131, may be mentioned, who reported about
experiments on the effect of longitudinal and transverse incisions of the spinal cord.
He found that, whilst a longitudinal incision in the cord had no demonstrable effect on
function, transverse incision resulted in paralysis of the body below the level of the
lesion. Paulus of Aegina, who modified Hippocrates' method of traction for vertebral
dislocations by external fixation of the reduced spine by a thin sheet of wood fixed along
the spine extending above and below the site of injury, can also be considered as the
originator of decompressive laminectomy and he also advocated removal of a fractured
spinous process causing pain. Antrine Louis (1762) successfully removed a bullet lodged
in the spine.
An important contribution at the end of the eighteenth century to the subject of
traumatic paraplegia, as a result of a fracture-dislocation of the I2th thoracic vertebra,
is the treatise of the German surgeon, J.Sommering (1793):
Bemerkungen uber Verren-
kung und Bruch des Ruckgraths.
In 1814, Henry Cline, a London surgeon, carried out a
laminectomy, but the patient died nine days later. It was in this first quarter of the
nineteenth century that arguments on indication and value of this operation were widely
discussed amongst leading members of the medical profession, and the management of
spinal injuries became a topic of real interest in England and other countries.
Throughout the nineteenth century, the general tendency in the treatment of spinal
cord injuries was to be conservative, and leading neurologists and surgeons threw the
weight of their authority against surgical treatment. There were a few prominent sup–
porters of operative treatment, such as Astley Cooper (1827), but, on the whole, Charles
Bell's view (1824) 'laying a patient upon his belly and by incisions laying bare the bones
of the spine, breaking up these bones and exposing the spinal marrow itself, exceeds all
belief was widely accepted. One of the famous personalities in British history of that
time, Lord Nelson, was one of the victims of a spinal cord injury, as a result of a gunshot
wound during the battle of Trafalgar, when the bullet, after penetrating the chest,
lodged in the thoracic spine, producing a paraplegia below the breast. The final scene
in Nelson's life was recorded by Beatty, the ship's surgeon, and has been described in
detail in Oliver Warner's book
Trafalgar,
from which the following is quoted: 'Mr
Beatty was called by Dr Scott to Nelson, who said "Ah, Mr Beatty! I have sent for
you to say what I forgot to tell you before, that all power of motion and feeling below my
