14
CHAPTER 2
opened in 1946 by the Joint Committee of the Red Cross Society and the Order of St
John of Jerusalem, where paraplegics live with their families in bungalows and work in
sheltered workshops within the Settlement.
5
Settlement for paraplegic ex-servicemen at Garston Manor, Watford. The residents
live in bungalows and all are employed outside the Settlement in open industry.
AFTER CARE SERVICE
A systematic out-patient service was organized in 1951 to deal with routine clinical
check-ups for the increasing number of patients discharged to their homes, paraplegic
settlements and other institutions, in particular for those who had found employment
and were anxious to have as little time off work as possible (see Chapter on Statistics).
When distance prevents out-patient check-ups, the paraplegic or tetraplegic is readmitted
for a day or two for the necessary check up. Alternatively, for those who are employed,
X-ray, blood and urine check-ups are carried out in their nearest hospital and results are
sent to the Centre for review to decide whether or not readmission for in-patient treat–
ment is indicated. This scheme has proved highly successful in maintaining so many
former patients in good health and employment for many years. For ex-service pensioners,
the Ministry of Pensions and Social Security has for many years arranged visits by their
regional doctors and welfare officers to the paraplegic's home and they will get in touch
with this Centre if any special social or medical problems arise. This after-care service
has also proved important in advising local authorities in the adjustment of the paraplegic's
or tetraplegic's home, by providing garages, widening doors, adjusting toilets and bath–
rooms, building ramps, etc. A close relationship between the Centre and the patient's
family-doctor is established once the patient is discharged from hospital.
TYPE OF CLINICAL MATERIAL TIME OF ADMISSION
Patients are admitted to the Spinal Centre at varying intervals after injury or onset of
disease and in many cases their condition is extremely serious. The patients admitted
can conveniently be divided into the following groups.
i
Patients admitted immediately or at an early date after injury
During the war they were admitted from first aid posts of the Normandy front or bombed
cities, arriving often with gaping wounds caused by bullets or shell fragments with or
without discharging cerebro-spinal fluid, or with associated injuries to other organs, or,
especially in air-raid victims, with associated fractures of ribs, skull and extremities.
Since the war, when the great majority of traumatic cord injuries have been due to closed
fractures or fracture-dislocations, patients have been admitted in ever increasing numbers
either immediately or within the first few days after injury from casualty departments of
general hospitals, or from accident, neurosurgical or orthopaedic hospitals. This has
been more and more recognized by surgeons as the most satisfactory procedure to
avoid early infection of the paralysed bladder and the development of other complica–
tions, especially pressure sores. In 1963, at a symposium on spinal cord injuries at the
