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Ludwig Guttmann, M.D. was a German-Jewish refugee who fled Nazi Germany in 1939 and joined the neurosurgical faculty at Oxford University in England. Prior to his leaving Germany, Dr. Guttmann was the assistant to the leading German neurosurgeon of that time, Otfrid Foester, at the University of Breslau. Forced out of the University of Breslau because of anti-Semitism in 1933, Dr. Guttmann became the Chief of Neurology and Neurosurgery at the Breslau Jewish Hospital. It was there that he developed many of the techniques to treat spinal cord injury that he used and perfected in England.
Up to the end of the 1930’s, the prognosis of a patient with traumatic paraplegia and/or quadriplegia was deplorable, with a mortality rate nearing eighty percent within a period of three months because of urinary tract infections and septicemia, pulmonary complications, and bed sores, to say nothing of the acute depressive state brought on by the condition.
Working in the Radcliffe Oxford University Hospital, Dr. Guttmann developed a comprehensive plan for the treatment of acute traumatic spinal cord injury which he presented to the Medical Research Council of England in 1941 in the form of a written report. This paper resulted in the establishment of a special center for spinal cord injuries which was located at the Stoke-Mandeville Hospital in Aylesbury, England and Dr. Guttmann was appointed director in 1943. An important reason for setting up this kind of a specialized unit was that with the invasion of Europe looming, it was realized that there would be a large number of traumatic spinal cord injuries occurring among the Allied soldiers. Of course the basic fact remains that from the time Dr. Guttmann arrived in England and started his clinical practice at the University Hospital in Oxford, to the submission of his medical report on the treatment of acute traumatic spinal cord injuries, he was able to implement a treatment regimen that reversed the eighty percent death rate to twenty percent, thus revolutionizing this once dreadful prognosis. One has to ask how it was possible for this advance to occur.
Professor Guttmann’s treatment philosophy was extraordinarily advanced for the time. He believed in treating the whole individual, his/her physical as well as emotional and psychological problems as well! Today we call this the “holistic” approach! Besides, he well understood from his work in Germany the insidiousness of the major cause of mortality, infection. So he developed techniques which consisted of meticulous preventative measures for the development of bedsores, involving frequent turning, bed contact surfaces without creases, ridges, or pressure points, near-sterile techniques for wound treatment or dressing changes, techniques of bladder catheterization that prevented overflow and over-filling, encouraging mobility and muscle strengthening in the spinal cord injured, nutritional support and the development of research programs to look at the many problems found in acute traumatic paraplegia and quadriplegia. The programs mentioned above initiated by Professor Guttmann were very demanding on both the nursing and medical staff and necessitated a revolutionary change in discipline. Dr. Guttmann was often seen visiting patients in the middle of the night to make sure that patients were turned frequently and their immediate environment impeccably clean.
The National Spinal Injuries Center at the Stoke-Mandeville Hospital was opened on February 1, 1944 with 26 beds and Dr. Guttmann as its Director. Within 6 months, the number of beds were expanded to 60 and the Center was used extensively to treat Allied soldiers during World War II. It became the Mecca for the treatment of the spinal cord injured patient and its influence has been world-wide in this field, if alone because of its medical and nursing training programs as well as the many research initiatives that started there.
The importance of regaining muscular strength in the paraplegic and quadriplegic was pioneered by Professor Guttmann by the use of sporting activities, since this type of exercise was part of his holistic philosophy in combatting the lack of self-esteem and the pervasive self-isolation and consequent depression that used to characterize the personality of these patients. This emphasis on sports for people with disabilities resulted in the first Stoke- Mandeville games that were held in 1948 where basketball and archery were highlighted and started the first day of the 1948 Olympic Games in London and then continued annually. In 1960 these games became an integral part of the Olympics in Rome and more than 350 athletes from 24 countries participated, being called the Paralympics in the year 1984. For the London Games in 2012, more than 14,000 athletes took part representing 140 countries in the Paralympics with some of the events taking place at the Guttmann Stadium at Stoke Mandeville.
Ludwig Guttmann, M.D. has won many awards and honors for his work on spinal cord injuries and rehabilitation, and in 1966 he was knighted by Queen Elizabeth II. He was responsible in many ways for the development of more than 40 other rehabilitation centers throughout the world and his incredible activity at Stoke-Mandeville unleashed an enormous amount of research resulting in the betterment of those suffering this type of injury. We are all indebted to this magnificent individual who truly brought light to the darkness surrounding those once suffering from a condition thought to be without hope! Professor Sir Ludwig Guttmann, M.D. passed away on March 18, 1980 at the age of 80.
article credit to
Maurice S. Albin, M.D., Professor of Anesthesiology
University of Alabama School of Medicine