CHAPTER 6
CONCLUSIONS
During the last 18 years, I visited 38 countries, some of them several times, at the
invitation of governments, universities and various organizations to study the problem of
paraplegia in the respective countries and advise in the management of these patients.
From all my observations, some of which are now recorded in this book, the following
conclusions may be made:
1
There is no doubt that today spinal paraplegia and tetraplegia are a world-wide
problem. It is no longer a medical problem alone but has developed also into a social
problem, increasing in size from year to year in all countries of the world, including the
so-called developing countries. One can already foresee that in 15-20 years at the latest
spinal paraplegia will be one of the major social problems of disablement.
2 The advances made in the medical and social rehabilitation of spinal cord sufferers
from injuries and diseases during the last 25 years is mainly due to the congregation of
these patients in Spinal Injuries Units under a specialist staff. By far the most favourable
results have been achieved in those Centres with their own director in charge, prepared
to forgo some of his original speciality for the multi-disciplinary speciality of spinal
paraplegia, which should have an equal status to that of any other sub-speciality of
medicine and surgery, such as chest, opthalmology, E.N.T., dermatology, etc.
3
The fragmentation of the management of the spinal paraplegic and tetraplegic into
immediate, intermediate treatment and the long-term physical, psychological and social
readjustment including domestic and professional or industrial resettlement, called
rehabilitation, has, as a rule, proved unsatisfactory, and from all that I have seen in
many countries often disastrous. For, those who advocated such fragmentation were and,
alas, still are concerned only with the treatment of some special procedures in which
they are skilled but on the other hand overlook and even neglect other vital aspects
in the immediate and early treatment of these patients, in particular the proper care of
the paralysed bladder. Only in those hospitals where the spinal specialist himself has no
surgical facilities but has access to and control of the whole management of these patients
from the start, have satisfactory results been achieved. In this respect, the Spinal Centres
at Heidelberg in Germany and Geneva in Switzerland can be quoted as excellent examples.
4
It is of lesser importance whether a Spinal Injuries Centre is established as part of a
General Hospital, Accident Hospital or other specialized departments such as Ortho–
paedic, Neurological, Neurosurgical, Urological Units or General Rehabilitation Centre,
or built as an autonomous centre such as those in Ostia-Rome and Barcelona, Spain.
The vital point is that a Spinal Injuries Centre must have its own director who is familiar
with all aspects of this complex problem of spinal paraplegia and can co-ordinate the
work of his whole team, as is done in any other speciality.
5 Amongst the various facilities necessary for a comprehensive management from the
start and throughout all stages, the provision of an operating theatre, facilities especially
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