A INTRODUCTION
5
chest are gone: and you very well know I can live but a short time .... You know I am
gone". The surgeon's reply was: "My Lord, unhappily for our Country, nothing can
be done for you."' Nelson died within a few hours. It is also of historical interest that,
on 2 July 1881, the 20th President of the United States of America, James A.Garfield,
became a victim of a spinal injury as a result of a gunshot injury resulting in an incom–
plete conus-cauda lesion, and died 79 days later. The Museum of the Armed Forces
Institute of Pathology in Washington has preserved the specimen of President Garfield's
shattered vertebrae. There is another vertebral specimen on show in the same Museum
namely, the upper cervical vertebrae of John Wilkes Booth, who made history as the
murderer of President Abraham Lincoln and who received a bullet wound through the
cervical cord. Recently (1972) Governor George Wallace of Alabama became a victim
of a spinal cord injury, following a gunshot wound during his election campaign. He
survived but is still chairbound.
The great developments in surgery in the Listerian period, Pasteur's work on
bacteriology, the introduction of ether anaesthesia, and later the discovery of X-ray by
Roentgen have, no doubt, modified the extreme conservative view, and the field of spinal
cord surgery has steadily been extended. However, the prognostic outlook of sufferers
from severe lesion of the spinal cord has remained extremely poor, and the mortality
rate in both peace and war has been very high. The hopeless frame of mind, held even
by experts, has been appropriately summarized by Wagner & Stolper (1898) on page 576
of their book:
Die Verletzungen der Wirbelsdule und des Ruckenmarks
(the injuries of the
spine and spinal cord), a book which up to the First World War was considered as a
standard work on the subject of spinal injuries. Their views are expressed as follows:
In complete lesions it is the physician's forlorn task, even while knowing that the patient
is approaching an early death, to keep him alive for weeks and months on end, only to see
him wretchedly fade away, despite all skill and efforts.
In the Balkan wars, the mortality rate after spinal cord injury was over 95 per cent,
and recollections of casualties with spinal cord injuries from the First World War and
the after-war period have also left depressing memories of hopelessness and helplessness.
The literature of that time in every country, though containing many excellent publica–
tions on problems of pathology and physiology, reveals a profound defeatist attitude of
the medical profession towards these unfortunate sufferers, when dealing with the
problem of prognosis and rehabilitation.
Harvey Gushing, the world famous neuro-surgeon and Consultant in Neurosurgery
to the American Army during the First World War, gave in 1927 a vivid description of
the pitiful fate of battle casualties with spinal cord injuries, 80 per cent of whom died
in the first two weeks. 'The conditions were such', he wrote 'owing to pressure of work,
as to make it almost impossible to give these unfortunate men the care their conditions
required. No water beds were available, and each case demands undivided attention of a
nurse trained in the care of paraplegics. Only those cases survived in which the spinal
lesion was a partial one.'
The mortality rate of traumatic paraplegics in the British Army was similar. The
early mortality (death within the first few weeks or months) varied from 47 to 65 per cent
(Vellacott & Webb-Joynson, 1919), and the overall mortality after three years was
