10
CHAPTER 2
of comradeship that has grown up in the services and in hospital'. It was this staff,
joined soon by Miss Joan Scruton as Secretary and later Administrator of the Unit
the only volunteer at that time who wanted to work in a Spinal Unit who were trained
in the details of meticulous care and various aspects of treatment and who developed
into an enthusiastic and devoted team, inspiring the patients to active and full co-opera–
tion. Naturally, the defeatist attitude of the many visitors had to be changed (see chapter
on Psychological Aspects). Indeed, in the first two years of our work the question that
was put to me with almost monotonous regularity by visitors from the medical and para–
medical professions as well as administrators was 'Is it really worth while ?'
Radical changes in the medical and psychological approach to the whole problem were
introduced, as has always been done in other pioneer work in medicine, to overcome
dogmas and prejudice. It was quite unorthodox in those days to reject the conventional
methods of recumbency and immobilization of traumatic paraplegics in plaster casts
and plaster beds as well as to abstain from hasty, indiscriminate operative procedures,
such as laminectomy and open reduction, as initial treatment of the broken spine and to
replace them by new methods aimed at the mobilization of the natural forces of repair
and readjustment so inherent in the human organism. It was, at that time, a new approach
for both medical and nursing staff to teach that bedsores resulting in osteomyelitis and
sepsis or ascending infection of the upper urinary tract and renal deficiency were by no
means inevitable consequences of spinal paraplegia, as commonly accepted, but that
these complications, as well as others such as contractures and intractable spasticity
could, by introducing new methods of management, not only be controlled but altogether
prevented. The continuous drainage of the paralysed bladder by immediate suprapubic
cystotomy, which in the Second World War was considered by most surgeons as the
method of choice for the initial treatment of the paralysed bladder, was rejected from a
point of principle as unphysiological. This method was replaced by the non-touch
technique of intermittent catheterization carried out in the acute stages by the medical
attendant himself and not, as was the custom, by nurses or orderlies. Above all, it was
quite revolutionary to teach and impress on the authorities of medical and social services,
in particular the Ministry of Labour and Housing Authorities, that the mere fact that a
person was a paraplegic did not justify care in one of the institutions for incurables, but
that in spite of permanent and severe physical handicap, rehabilitation to a useful life and
employment was possible. With this object in view, regular work and sport were intro–
duced from the beginning as essential parts of the clinical treatment of these patients
which, in due course, proved so very successful for their physical, psychological and
social rehabilitation.
Actually, the first industrial experiment to prove that paraplegics in their wheelchairs
could work in a factory side by side and in competition with able-bodied workers was
carried out with our first six rehabilitated paraplegic ex-servicemen at the end of 1944.
Naturally, this achievement had a remarkable, psychological effect on the rest of the
patients and gave them encouragement and hope for their future. It was the team-spirit
on the part of my initial staff and the early patients which enabled us to prove within a
short period of i^ years that the new philosophy in the approach to the management of
these patients could be put into practice (Guttmann 1945).
