F- CLINICAL ASPECTS OF SPINAL CORD INJURIES
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in the toes, thus increasing spasms of the paralysed legs, but by inevitably becoming
infected they are a potential danger to the general condition of the patient.
ILL-EFFECTS OF HEAT AND COLD
The loss of sensibility in the paralysed part of the body includes the loss of appreciation
of heat and cold. Objects, commonly used in daily life, may produce the most frightful
burns in these cases. The hot-water bottle was found to be the main cause of burns in
those paraplegics admitted with burns to this centre, and its use should never be allowed
in these cases, even if protected by a cover. Instead, woollen bed-socks should be worn in
bed in cold weather. The next on the list is the hot-water tap of the bath—especially
in the case of ambulant patients. A paraplegic, before getting into the bath, should first
make sure that the hot-water tap of the bath is completely turned off, and in bath-tubs for
paraplegics it is preferable to have water taps situated in the middle of the bath instead
of at the end. Wash-basins for paraplegics, which must be high enough to allow the
wheelchair to be drawn up close to them, should have a bar on the floor to prevent the
insensitive knees being burnt by the waste pipe when containing hot water. Spilling hot tea
or coffee may result in scalding of the insensitive skin, and this is particular hazard for the
female paraplegic when working with a kettle or saucepan from a wheelchair. This hazard
can be best prevented or at least diminished by enlarging the space of the kitchen to
facilitate better manoeuvring with the wheelchair and lowering the level of the electric or
gas cooker as well as the sink to make work in the kitchen easier. One of our paraplegics
developed severe burns of his feet in his car when the engine's heat made the metal
under the front seat hot. Tetraplegics with sensory impairment in the fingers should
always smoke with a holder to avoid burning. A further cause of burns in paraplegics is
sitting too close to an open fireplace or electric fire, and when in such a position the
limbs should always be protected. Precautions should also be taken in hot weather,
when exposing the body to the direct sun in high thoracic and cervical lesions where the
spinal heat-regulating mechanisms are impaired, as otherwise this may also have ill-effects.
Cold may also have ill-effects. Every paraplegic and tetraplegic with spasticity very
soon becomes aware of the increase of flexor or extensor spasms when the paralysed
part of the body is exposed to cold. Even more serious can be the effect of cold on the
blood circulation in the distal parts of the lower limbs in certain cauda equina and conus
lesions, which can result in permanent damage of the small vessels of the toes and feet as
shown by their pinkish-blue colour and development of frost-bite. A useful precautionary
measure is to prevent the legs being kept continuously in one position. Long woollen
pants, woollen socks and warm, loose fitting shoes or fur-lined boots have proved bene
ficial, especially for those paraplegics engaged in factory work.
PRESSURE SORES
Definition and terminology
This condition is liable to develop in persons suffering from prolonged debilitating
illnesses such as cachexia due to malnutrition, general shock following injury or burns,
