A-INTRODUCTION
7
number of years to other forms of disablement such as blind, amputees and other crippling
diseases. In this connection the first 'Discussion on Rehabilitation of Injuries to the
Central Nervous System' held in 1941 in the Royal Society of Medicine may be men–
tioned. Four speakers discussed brain injuries and one (myself) peripheral nerve injuries,
while the subject of spinal cord injuries was not even mentioned.
A NEW APPROACH
A fundamental step forwards in a new approach to the problem of management of spinal
cord sufferers was taken during the Second World War by the Peripheral Nerve Com–
mittee of the Medical Research Council, under the leadership of Dr George Riddoch,
Neurological Consultant to the British Army and the Ministries of Health and Pensions,
who decided to congregate spinal cord casualties in special Spinal Injuries Units within
various E.M.S. and Ministry of Pensions Hospitals in Great Britain, for it was antici–
pated that the number of war casualties with spinal cord injuries would be considerably
increased by air raid casualties amongst civilians. There were several reasons for this
decision: first of all, it was generally agreed that conditions for a systematic study of the
many aspects concerned with the treatment and rehabilitation of spinal paraplegics
were infinitely more favourable in a spinal unit than when these cases lay scattered in
general medical or surgical wards, from which, as a rule, they were transferred to chronic
wards or homes for incurables. Even if they were admitted to neurological, neuro-
surgical, orthopaedic or urological units, the facilities available were limited to the
study of specialized problems and short-term treatment only. Above all, these depart–
ments were so busy with their many other afflictions in their own specialities that, as a
rule, it was quite impossible for both the medical and nursing staff to give spinal para–
plegics let alone tetraplegics, that meticulous care and attention which these patients
need day and night, especially during the acute stages.
During the course of the war, twelve spinal units were gradually set up in various
parts of this country, where most of the 700 odd casualties with spinal cord lesions
were collected (Winwick, Warrington; Barnsley Hall, Basingstoke; Warncliffe, Sheffield;
Chapel Allerton, Leeds; Ronkswood, Worcester; Dunstan Hill, Newcastle; Rookwood,
Cardiff; Llandrindod Wells; Stanmore, London; Leatherhead, Surrey; and Edinburgh).
However, in those days, it was not generally recognized by both the medical and
administrative authorities that, in order to prevent these spinal units becoming merely an
accumulation of doomed cripples,
the provision of certain arrangements was
indispensable.
i Most important of all, supervision of such a unit by an experienced physician or
surgeon, who was prepared to give up part of his own speciality in order to devote his
full time to the work which demanded meticulous attention to detail, to plan and organize
the many details of treatment and lastly but by no means least to correlate the sometimes
conflicting interests of the visiting medical and surgical specialists concerned with the
immediate and long term management of paraplegics and tetraplegics. The organization
should be such that the paralysed patient is never in doubt which is the doctor who is
looking after him.
