Report written by Russell Barbour MS, FRCS “The Development of the Paraplegic Unit, Royal Adelaide Hospital” in 1966.
Introduction
From the time of the Hippocratic writings it was recognised that spinal injury could be accompanied by paralysis.
This was reckoned a serious invaliding injury.
Down the centuries such victims of paraplegia continued to be invalids, probably due to two factors:
- Medical care was directed entirely to the paralysed parts and organs;
- These cases were treated in the general medical stream and not segregated.
There was no progress made until at the end of World War II, when a number of Spinal Injury Centres were set up in the U.K. to handle the casualties from the invasion of Europe. The best known was conducted by Dr. Ludwig Guttmann at Stoke Mandeville, U.K. He proved that such patients were not hopeless, but could be independent active citizens in a wheelchair and moreover athletes. This was a great advance and the doctrine of reversing the previous approach spread throughout the world:
- Make the best use of what is not paralysed;
- Separate cases from the general medical stream, to allow concentration on the specialised work of restoring paraplegics to active citizenship, in a Paraplegic Unit.
Post World War II
In South Australia at the end of World War II, this problem was recognised but without knowledge of overseas development. Some cases under my care at the Military Hospital at Springbank joined the Canadian Paraplegic Association. One in particular was subsequently active in visiting and assisting civilian patients at Royal Adelaide Hospital. He was Capt. D. K. Munro, R.A.A.O.C., paraplegic from a gun shot wound at waist level. He had a troubled convalescence but successfully carried on his work besides assisting others. He, with Mr. Stan Schebella, who was injured in 1950, eventually formed a South Australian Association with a number of doctors and other people including Mr. Frank Walsh, the present Premier, on the Committee. This Association however, seemed to make little progress.
Early in the 1950’s, Dr. George Bedbrook, a trainee of Dr. Guttmann, established the first Australian Paraplegic Unit at Shenton Park Annexe of the Royal Perth Hospital. In 1957, Dr. Guttmann visited Australia and with his support a group of medical men approached the Premier of South Australia, requesting that a Paraplegic Unit be formed.
Because there was no evidence of need, or staff for such a project, it was refused.
These early and desultory approaches to the treatment of paraplegia had accomplished very little.
The Establishment
In 1958, at Royal Adelaide Hospital, an Assistant Honorary Surgeon Mr LL Hoare and myself, an Honorary Orthopaedic Surgeon, decided a Paraplegic Unit was essential. Therefore, with the concurrence of my fellow Orthopaedic Surgeon, Mr Neville Wilson, I proceeded to gather all the Paraplegic and Quadriplegic cases into the Orthopaedic Wards. This was easy because these cases were considered chronic invalids in the Surgical Wards.
Soon the number of spinal injuries with paraplegia crowded the Orthopaedic Wards and the only way for the Orthopaedic Clinics to function was in ‘borrowed beds’ in other wards of the hospital.
At this stage, a threefold pressure was built up to establish a Paraplegic Unit:
- The Orthopaedic beds were occupied by these cases and the General Surgeons were complaining that the Orthopaedic Clinics were monopolising too many of their beds in securing necessary holding space;
- It was requested of the Minister of Health, Sir Lyell McEwin, that all new cases of spinal injury with paraplegia should be flown to the Perth Paraplegic Unit because we had no such facility in Adelaide and it should not be denied to these patients. The Minister agreed to this procedure and personally confirmed each transfer. An expensive business, well calculated to encourage the development of a South Australian Unit.
- We had established the need for a Unit in South Australia and the active staff at that time indicated that there were medical officers anxious to staff it. The personnel concerned were myself, Mr LL Hoare (Registrar ), Mr MR Hone, and most important Sister T Stewart of the Nursing Staff.
We continued to improve the treatment of these Spinal Injuries with Paraplegia and also to embarrass the administration of Royal Adelaide Hospital until recognition occurred.
The first move was an outstanding one. The Medical Superintendent agreed to establish a Paraplegic Unit. His formula was to reduce the beds allotted to Orthopaedics in their wards and nominate the remainder as a Paraplegic Unit. A master stroke: the beds were still filled by the same patients!
Morris Hospital
Late in 1961, the first real gain occurred. The Director General, Dr JW Rollison suggested that as the demand for beds for Tuberculosis had eased, perhaps the Paraplegic Unit could use Ward 4 at the Morris Hospital. We viewed Ward 4, a pavilion type block on flat ground with open space for therapeutic sports: it was ideal. There was then a rapid, perhaps feverish, organisation of this Ward. The personnel had changed a little in the Paraplegic Unit, now readily accepted. Mr MR Hone (Registrar) was overseas and Mr DC Paterson was in his place. Sister T Stewart was on administrative work and was replaced by Sister J Tyler. Mr BL Cornish was Honorary Clinical Assistant.
At the beginning of 1962, the Paraplegic Unit, greatly assisted by the Administrator and Medical Superintendent, Royal Adelaide Hospital, really took shape. There were 10 beds at the Royal Adelaide Hospital for immediate cases and surgery, there were 26 beds at Morris Hospital as Phase 2; patients were to be moved between these two sites as necessary.
The establishment of the Unit was laid down with Honorary Medical Officers, Residents, trained Sisters and Probationers, Nursing Aids and male Orderlies. Besides these, there were Physiotherapists, Physical Training Instructors, Social workers and an Occupational Therapist. A big team, but if a Paraplegic can be made a happy and independent citizen in a few months, instead of an invalid, it is worthwhile.
The development of the Unit proceeded. Phase I at Royal Adelaide Hospital became well organised and highly efficient. The medical profession and Ambulance Services (St. John) were acquainted with the needs of these spinal injuries and co-operated. The Board of Royal Adelaide Hospital agreed that Medical Officers of the Unit should proceed to collect cases of spinal injury with paraplegia from the site of injury for their safe keeping. A great advance, compared to meeting them at the front door – if they got so far. This at times involved air transport via St. John, and was a step forward.
Phase 2 of the Unit, Morris Hospital was reorganised to alter toilet blocks, establish therapeutic playing fields and modify existing huts for physiotherapy etc.
Supervision of work at the Morris Hospital had necessitated a daily visit by one of the Honorary Medical Officers and a Grand Round once a week. Travelling time was half an hour besides working time in the ward: a burden if a necessary one.
This was improved in 1963 by the appointment of a part time Assistant Director Mr MR Hone to conduct the day-to-day management.
The Official support from Royal Adelaide Hospital and the Minister of Health was now so strong that in 1963, the Australian Paraplegic Games were staged at the Morris Hospital. Providing accommodation for some 70 interstate wheelchair athletes and venue for sports including basketball, archery, field events, snooker and fencing. A vast change.
This development was not at all easy, mainly because of the personality of the then Medical Superintendent of the Morris Hospital. The administrative chain of command was repeatedly recommended by the Director General as being quite clear; we of the Paraplegic Unit staff found it most difficult. In fact, this one handicap nearly led to us abandoning a Paraplegic Unit: eventually this difficulty was eased by replacement of the Medical Superintendent of Morris Hospital. The Paraplegic Unit serving South Australia, Northern Territory and the real but undefined ‘Central Australia’ was nearly abandoned because of administrative difficulty.
The Ancillary Services
The successful treatment of paraplegia is not only peculiar in needing segregation in a unit specially devoted to this aim. It also requires aftercare and support in the community for these wheelchair citizens. The housing, transport, factories and public services are ill adapted to wheelchair people. Sports and recreations need assistance besides adequate transport and organisations adapted to such people.
Therefore a Paraplegic Association is required to assist the Paraplegic Unit and the people treated there, as a Community Service.
When the Royal Adelaide Hospital Paraplegic Unit came into being at the beginning of 1962, I was fortunate in co-opting the help of a number of business people in forming the Paraplegic Association of South Australia, Inc. These included: HC Pope, SC Williams, Miss N Simonds, Gordon Reid of ‘Phoenix’ and the Rev. Kenneth Jenkins of the Tuberculosis Association. They joined with established paraplegics and a medical panel. The Patron was Sir Henry Newland and Vice-Patrons Sir Leonard Lindon and Mr HH Harvey.
An active support and with the assistance of Lions Club Adelaide Light, we secured a vehicle to transport patients in wheelchairs between the two phases of the Unit, Bedford Industries and Phoenix Sheltered workshops for treatment and training to independent employment.
Lions Club Port Adelaide donated 20 specially constructed chairs for therapeutic sports. Many other organisations assisted the unit and the Association in re-establishing Spinal Injuries with Paraplegia as active citizens.
A Women’s Auxiliary of the Association was formed and contributed a second vehicle for use at the Unit, not only for transport but as a training in hand-controlled driving for patients.
This community counterpart of the Medical Unit continues and by June, 1967, we expect the first section of a treatment block at the Morris Hospital to be completed. It will be a therapeutic pool built by the Government but greatly subsidised by funds from Lions Club Port Adelaide and the Paraplegic Association of South Australia Inc.
After centuries of despair in the treatment of Paraplegia, the world has gained knowledge to cope with it. In 1962 in South Australia, the third Australian Paraplegic Unit was established at Royal Adelaide Hospital and is proving, as other units have done, that Spinal Injury with paraplegia is not the end of a life, it is the beginning of an altered life that can be worthwhile.
The Paraplegic Association of South Australia has now a Division at Mt Gambier and is a member of the Australian Paraplegic Council, the federal representative of the Paraplegics and Quadriplegics in Australia and internationally.