A- INTRODUCTION
15
Royal College of Surgeons in Edinburgh, I reported that of 396 traumatic paraplegics
and tetraplegics admitted during the first 15 days between 1957-63, out of a total admis–
sion of 744 cases, 85 were admitted on the day injury, and 234 within 48 hours, 109 of
them on the day after injury. The largest group of immediate admissions were the tetra–
plegics (87), the second largest the thoracic lesions between T6-TI2 (78). It may be
noted that many of these cases were also suffering from associated injuries of various
kinds. The beneficial effect of an immediate or very early admission of these casualties
will be discussed in the chapters on pressure sores and urological aspects. In traumatic
patients, who for one reason or another are not immediately transportable, the medical
or surgical officer in charge of the case often contacts the director of the Spinal Centre
to discuss the case and seek advice about aspects of early management, especially the
paralysed bladder, or the director or one of his senior colleagues is called in for immediate
consultation. Early admission of non-traumatic patients include those following operative
procedures for the removal of tumours or prolasped intervertebral discs, acute vascular
lesions, transverse myelitis and epidural abscesses.
2
Patients admitted at later dates
(a) These are cases admitted with signs of septic absorption resulting from infection of
the urinary tract producing calculosis or hydroureter, hydro- and pyonephrosis or
patients suffering from pressure sores of various size and depth, often producing osteo–
myelitis with or without destruction of joints. Many of this group show signs of nutri–
tional deficiency and, especially during the early years of our work, showed extreme
degrees of malnutrition comparable with those found in inmates of concentration camps.
(Belsen type of paraplegics). Fig. 6 demonstrates a woman who was stabbed by her
husband and sustained a severe incomplete thoracic cord injury. She was admitted in a
pitiful state of malnutrition from a general hospital 4 months after injury suffering from
sepsis as a result of pressure sores and infection of the urinary tract. The following pic–
tures show various stages of rehabilitation. Nothing can explain more strikingly the
difference between inadequate treatment and proper comprehensive management in
traumatic paraplegia than the facial expression of one of our early patients an ex-service–
man at the time of admission to the Spinal Centre and time of discharge. (Fig. 7).
(b) Another group of late arrivals are patients where pain and intractable spasticity
overlaid by contractures are found in the foreground of the clinical symptomatology.
Fig. 8 shows a young soldier admitted from a General Hospital after 4 months, following
traumatic tetraplegia below C6/7 with profound flexion contractures of the forearms due
to faulty positioning. The agony of suffering from pain is shown in the patient's face when
the sister tried to extend the forearm. However, by appropriate measures (see Chapter
on Physiotherapy) the severe contractures could be overcome, as shown in the photo–
graphs made during the later stages of management. This group also includes patients
with flaccid paralysis who, through inadequate treatment or neglect, have developed
deformities of spine and limbs.
(c) A further group of late arrivals are those with more or less satisfactory physical
condition but who are demoralized as a result of prolonged and enforced inactivity in
