A INTRODUCTION
35
1957 there was only one Spinal Injuries Unit established for comprehensive management,
that set up in 1955 under Dr R.Lipschitz, neurosurgeon, at the Baragwanath Hospital
outside Johannesburg, for coloured people only. At that time, the great majority of
spinal cord injuries were caused by stab wounds. In 1967, Lipschitz reported at the
annual meeting of the International Medical Society of Paraplegia on 252 stab wounds
of the spinal cord collected during a period of 12 years. During my recent visit in March
1969, the number of stab wound injuries in that unit had greatly diminished, and this
was the result of improved socio-economic conditions amongst the Africans living in and
around Johannesburg. The other large Spinal Injuries Centre was opened in 1963 by
the urologist Dr T.Retief and Dr A.Key at the Conradie Hospital, Cape Town, which
copes with all traumatic paraplegics and tetraplegics from the whole Cape Province,
which extends about 800 miles north and 1,000 miles east of Cape Town. Conradie is
a general hospital of single-storeyed bungalow type with a complement of 660 beds, very
suitable for the 120 wheelchair patients of the Spinal Centre. From its inception, this
Spinal Centre insisted on the immediate admission of patients and this has been achieved
by the ready co-operation of the Hospital Administration of the Cape Province. Dr Key,
who is now in charge of the Centre, has given an excellent survey of the first 300 new
cases of a total of 487 admissions between 1963 and 1967. The majority of new injuries
were admitted within 48 hours and 52 within a week. One hundred and five patients
from hospitals outside Cape Town were transferred by air. The ratio male to female was
9:1. Amongst the causes of spinal cord lesions, 70 (23) were due to stab wounds.
According to Dr Key's latest statistic (1971) this number has increased to 200 (see chapter
on Stab Wounds). The majority (135) were cervical injuries. The mortality rate by 1967
was 13 per cent. Two hundred and fifty-four were discharged, of these 219 to their
own homes and 29 to hostels. The Cape Town Spinal Centre has also organized a follow-
up service of its patients. Only those too far afield are supervised by the nearest provin–
cial hospital, general practitioner or district surgeon. There have been smaller Spinal
Injuries Units set up in South Africa in recent years: one by Professor du Toit at the
Orthopaedic University Clinic in Pretoria and one of the Hospital of the Gold Mines for
African workers, most of whom are re-employed as surface workers under sheltered
conditions after completion of their rehabilitation. Sport plays an important part in the
rehabilitation and teams have taken part in the Stoke Mandeville Games.
SPAIN
The first Spinal Injuries Centre in Spain (Institute Guttmann) was founded in 1965
in Barcelona by Seiior Gonzales, a former tetraplegic patient of Stoke Mandeville. This
Centre has been set up in a dilapidated hospital for venereal diseases which was given
rent free to Mr Gonzales by the Government and which had to be completely recon–
structed for the purpose of an autonomous Spinal Injuries Centre. The medical director
is Dr M.Sarrias Domingo, an orthopaedic surgeon and former trainee of Stoke Mande–
ville. The Centre is legally connected with the National Association of Civilian Invalids.
The Centre has its own operating theatre, X-ray equipment, laboratory and all facilities
for the immediate and long-term management, including educational and recreational
