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CHAPTER 6
for urological diagnoses and treatment. X-ray facilities, adequate provisions for physio–
therapy, work-therapy and sport are the most important necessities.
6 The size of a Spinal Injuries Centre has been under discussion for some time. In
particular, it was feared that a Spinal Centre of larger size in a general hospital might be a
hindrance to the development of other specialities. The Stoke Mandeville Centre has
proved, beyond all shadow of doubt, that a centre, even of its large size which, as a
national institution, served the whole country for many years, has been no detriment to
the development of other medical or surgical specialities. On the contrary, for those
specialities serving the local or regional population, such as medical, surgical, rheumatic,
paediatric, plastic surgery, geriatric units, etc., the existence of the Spinal Centre,
far from being a hindrance, has afforded facilities which these units have been able to
utilize most advantageously for their own purposes. On the other hand, the spinal
centre, as any other unit, has been using the facilities of the general hospital, such as
X-ray department, operating theatre, pathology laboratory, etc., and has enjoyed
throughout the years a close co-operation with the consultants of other units who have
been readily available when the need arose. Therefore, from all our experience, it can be
concluded that the setting-up of a spinal centre in a general hospital, as a speciality of its
own, represents at least one satisfactory solution.
From all my experience gained during my visits to so many countries in all parts of the
world, I have come to the conclusion that for industrialized countries the most economical
size of a Spinal Injuries Centre, equipped with all facilities for a comprehensive manage–
ment of paraplegics and tetraplegics through their acute and later stages, should be at
least 50 beds, divided for men, women and children. This figure should not be taken
dogmatically and, whatever the initial number of beds for the start may be, provision
should be made immediately for a final complement of 100 beds.
7 A Spinal Centre should be attached to, or at least work in close co-operation with, a
Teaching Hospital of a University and should take part in the training of undergraduate
and post-graduate medical and para-medical personnel. This is the best guarantee to
disseminate understanding and knowledge of the whole complex problem amongst the
medical and paramedical professions.
8 The establishment of a hostel in the neighbourhood of the centre, equipped with a
sheltered workshop, is essential for the accommodation of tetraplegics and paraplegics,
who for one reason or another are unable to return to their own homes. This is of parti–
cular importance for the developing countries, where the return of spinal paraplegics,
let alone tetraplegics, to their villages in the bush following successful rehabilitation in
hospital usually means immediate deterioration and early death, thus wasting all the
public money which was spent for the rehabilitation of the paralysed, quite apart from
the humanitarian aspect. The establishment of a 'Flying Doctor' service which has
proved to be very successful in Australia and Ireland for transferring to the Centre acute
traumatic paraplegics and tetraplegics from the place of accident or hospitals which are
not equipped for their treatment, is indeed highly recommendable, as this will obviate
early complications such as infection of the paralysed bladder and the development of
pressure sores which occur so very often in hospitals lacking in knowledge and facilities
for a comprehensive treatment of these complicated patients.
