The Spinal Unit at Stoke Mandeville Hospital opened on 1 February 1944, with one ward, 28 beds and a pessimistic, dispirited staff. This pessimism was well founded. Even Ludwig Guttmann recognised that spinal cord injuries were “the most depressing and neglected subject of all medicine”. About 80% of those with a spinal cord injury died within three years from sepsis caused by pressure sores or urinary tract infections. Those who survived lived as dependents with relatives or in homes for the ‘incurable’.
Guttmann’s philosophy was “to transform a hopeless and helpless spinally paralysed individual into a tax-payer”.
Guttmann believed that health complications from spinal cord injuries could be controlled or avoided. To minimise pressure sores, staff turned patients every two hours, day and night, whether the patients were asleep or awake. Guttmann turned up on the wards at odd times to check that his staff was complying. He also initiated an alternative way to discharge urine from patients who had lost control of their bladders. Instead of the making an incision through the body wall and connecting the bladder to an external box, urine was drained by catheterisation with strict aseptic procedures. These two changes, along with antibiotics, greatly improved the health of those with spinal cord injuries and markedly reduced the fatality rate.
Rehabilitation was the next priority. Guttmann applied contemporary rehabilitation practices including physiotherapy, remedial exercises and occupational therapy to patients who had previously been denied these approaches in favour of bed rest and therapeutic massage. He rarely advocated surgery for spinal injuries. Active physiotherapy, remedial exercises and occupational therapy were compulsory for all patients to gain strength, tone and dexterity in their upper bodies. Bed-ridden patients caught medicine balls and those more advanced in their rehabilitation were taken to the physiotherapy room where they worked on parallel bars, hit punch balls and climbed ropes. To motivate patients and stimulate confidence and encouragement for onlookers, activities such as walking with calipers between parallel bars were carried out in the wards.
Complementing these physical activities were occupational therapies that eventually enabled patients to practice carpentry and make and repair shoes, watches and clocks. There were also choirs, drama societies, concerts and reviews.
In these ways, Guttmann and his staff attempted to alleviate boredom, build confidence, reduce depression and provide a sense of life beyond the institution, with the ultimate goal of reintegration into society.
The results obtained at Stoke Mandeville were dramatic and it wasn’t long before Guttmann’s strategies were being followed at other hospitals in England and then around the world.