History of the National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury

Abstract

It has never been unequivocally established whether or not the spinal cord, chronically isolated from the brain above the thoracic sympathetic outflow, plays any part in temperature regulation. Animals, kept in rooms at an air temperature of 800 F (26.50 C), after chronic traumatic lesions of the spinal cord, behave essentially as poikilotherms (Pfluiger, 1878;Pembrey, 1897; Freund & Strassmann, 1912;Sherrington, 1924), but if they are kept at 60-700 F (15.6-21.1l C) they appear to regain some measure of temperature regulation against cold (Thauer, 1939;Clark, 1940). Studies on man are equivocal. Some authors claim that patients with acute traumatic lesions in the lower cervical segments are, initially, hyperthermic but later regain an ability to sweat (Foerster, 1936). Others state that they are hypothermic (Holmes, 1915).The experimental studies reported in this paper were made on human male patients, who, with one exception, had complete lesions due to injuries at various levels in the spinal cord, in order to study further the nature of the thermo-regulatory processes in spinal man. The subjects comprised one normal man, four patients with lesions at segmental levels between C6 and T1, one with a lesion below T 4 and one with a lesion below T 8. In all patients many months had elapsed since their injuries to the spinal cord. These subjects were exposed at rest and naked for 1-2 hr at air temperatures of 18-20, 28 and 35370 C. These temperatures and the design of the experiments were chosen to effect a comparison with the data of Hardy & du Bois (1938, 1941) and so to bring out any alteration in the thermoregulatory processes due to the cord lesions. METHODSThe patients were all in good physical condition. None had bedsores nor urinary infection of any consequence. The cervical lesion patients and theT4 patientwere bed-ridden and subject,therefore. to a smaller range of fluctuation in environmental temperatures than the other men. The wards THERMOREGULATION IN SPINAL MAN 407 of this hospital were neither centrally heated nor air-conditioned, and hence the microclimate of these patients probably shows a considerable variation between winter and summer. Their physical characteristics are given in Table 1.The same experimental procedure was adopted in each study. The subjects were stripped and rested nude for 1 hr on hospital beds at an environmental temperature of 270 C. Thereafter they were transferred either to an environmental temperature of 18-20 or 35-37O C for 1i-2 hr. The cold temperature conditions were obtained in a room open to the outside air, but shielded from direct and most reflected radiation from the sun on the colder days of the summers of 1954 and 1956. Air in the room was circulated slowly by means of a small electric fan to avoid gradients.The study at 35-37°C was made in a specially constructed 'hot box' (Guttmann, 1947). The heat source was a series of infra-red electric heaters in the roof of the box, but the patient was shielded from direct radiation. The air heated in this way was circ...

First Descriptions of Initial Management

“…Another major Spinal Unit was organized by Sir Ludwig Guttmann, a neurologist and neurosurgeon who escaped from Germany to England in 1939 and in 1944 founded a Spinal Unit at Stoke-Mandeville Hospital in Aylesbury [ 23 ] . He emulated the work of Munro and he also treated spinal cord injury as a complex disease.…”

“…Another paper describes the management of the acute stage of spinal cord injury in Stoke Mandeville National Spinal Injury Center. Guttmann later published a remarkable series of papers detailing each of his observations [23][24][25][26][27][28] .…”

Neurophysiology of Male Sexual Dysfunction in Neurologic Disorders

“…Intrathecal injection of an anticholinesterase, such as neostigmine, has been reported to induce erection as well as ejaculation. 15 In contrast, patients with sacral (conus medullaris) and cauda equina lesions are impotent in 70% of cases. Since sacral sensation is absent in these patients, reflex erections are presumably impossible.…”

Comparative analysis of the therapy of acute transverse myelitis

“…According to Buchan et al (1972), patients suffering from multiple sclerosis and encephalo myelitis, ATM accounts for 8'7 per cent of paraplegiae. In a group of 3000 cases admitted to Stoke Mandeville Spinal Injury Centre, cases of transverse myelitis accounted for 5'3 per cent (Guttmann, 1967). Moreover, there are not many studies on therapy and prognosis of ATM.…”