Silver, John Russell; (2002) The development of the modern ideas of treatment of spinal injuries. Doctoral thesis (M.D), UCL (University College London).

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Abstract

Injury of the spinal cord has been known since antiquity. The spinal cord cannot be repaired. Treatment consists of preventing complications until the spine has stabilised and the patient can be rehabilitated to an independent life. Surgeons have concentrated upon carrying out an operation on the spine. There has been no improvement in treatment until the beginning of the 20th century. The development of treatment in the Ancient World and the Middle Ages until Paré is explored. After Paré medical traditions separated. In the 19th century the controversies over surgery in the United Kingdom between Cooper and Bell are described. The First World War led to the setting up of the first spinal unit in the United Kingdom with outstanding work by Head, Riddoch and Holmes. This work ceased and patients were looked after on a custodial basis at the Royal Star and Garter Home. The Second World War led to the development of modern treatment in the United Kingdom and Guttmann's role is evaluated. In the United States Munro developed the first spinal unit in 1936 and pioneered treatment. Initially Canada followed and then excelled the United States. In Germany, the leading country in Europe medically at the end of the 19th century, work started with Wagner and Kocher and was developed by the anatomical and physiological work of Foerster. The failure of treatment to evolve in Germany was due to the advent of the Nazi party with its policies of euthanasia, anti-intellectualism and anti-semitism. In France the descriptive work of Dupuytren, Duchenne and Charcot is presented. The therapeutic work of Dejerine and Marie, who set up the first French spinal units in the First World War, is evaluated. The failure of treatment to evolve is explored.

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