Haematology in Diagnosis and Treatment

EDWIN SMITH'S papyrus of 1700 B.C. desciibes traumatic paraplegia as "a disease not to be treated." As recently as 1942 Elsberg in his classic monograph on spinal lesions wrote that "a complete transection" of the spinal cord is lethal." Yet, less than 20 years later, reports from spinal treatment centres indicated that 70 per cent of patients with severe spinal cord injury can survive, usually to an acceptable life. Dr. Benes' book describes how this transformation has been brought about. Dr. Benes, of the Neurosurgical Clinic of Charles University, Prague, records his experience with 241 patients who suffered severe spinal cord injury. The chapters on diagnosis, the principles of conservative treatment and the management of sequelae such as urinary infection and bedsores can be particularly recommended to those who wish to learn about modern methods. Improvement in the quality and duration of life after spinal injury depends on the measures described in these chapters. To the specialist, the book's chief interest lies in the controversial section on treatment. Dr. Benes advocates early spinal cord decompression for most patients with severe cord injury. Many will agree that surgery can benefit the patient with an incomplete spinal cord lesion who is undergoing progressive neurological deterioration. The majority of patients however show evidenice of severe spinal cord damage from the time of injury. Dr. Benes' results do not provide convincing evidence that such patients are helped by surgery. But this section, provocatively written, repays study as one of the few attempts to compare the merits of surgical and conservative treatment in the early hours after injury. Now that survival is likely, the early management becomes more important than ever. The book concludes with chapters on likely developments in rehabilitation. The need for spinal injury treatment centres is, of course, axiomatic. In the technical field Dr. Benes sees more hope in cybernetic prostheses ("the semi-artificial nervous system" of Wiener) than in nerve anastomoses or by pass operations. Future advances may derive more from engineering than from medical science. D.S.G.