1036 PROFESSOR LUDWIG GUTTMANN-TRANSFORMING THE UROLOGICAL CARE OF SPINAL INJURED PATIENTS

Abstract

INTRODUCTION AND OBJECTIVES: In 1944 the life expectancy for a patient with spinal cord injury was three months. Pressure sores and urinary infections accounted for the majority of deaths. Guttmann’s early understanding of the neuropathic bladder revolutionised the care of these patients, establishing principles that are universally practiced today. METHODS: A hand search of original material at the Wilfred Stokes Library in Stoke Mandeville was carried out and relevant books and papers obtained. Additional information was obtained from The Poppa Guttmann Recognition and Celebration Project and by contacting patients who were under his care. RESULTS: Ludwig Guttmann was born in July 1899 in Tost, Germany. He volunteered at a hospital after school and came into contact with spine-injured coal miners whose prognoses were invariably poor. During his early years in the UK he published work on the management of spinal injuries patients. The British Government, anticipating an increase of such patients due to the war, opened the Stoke Mandeville Spinal Injuries Centre and appointed Guttmann as director in 1944. Guttmann recognised the importance of bladder drainage and advocated no touch intermittent catheterisation (NTIC). Leading authorities at the time advocated the technique of cutaneous vesicostomy for spinal patients and dismissed NTIC as certain to lead to disaster. Guttmann opposed this view and presented the complications of cutaneous vesicostomy. He understood that indwelling catheters and foreign bodies became colonised with bacteria and demonstrated that NTIC maintained the sterility of urine and reduced the complications of bladder calculi and fistulae. Guttmann published research regarding autonomic reflexes upon bladder distension in spinal-injured patients. His observations were meticulous, describing the reflexes in patients with various levels of spinal injury. Guttmann’s practice extended to the holistic care of his patients and he worked hard to overcome the prejudices that were strongly held against his patients. He recognised that sport and work could help with rehabilitation and he established the Stoke Mandeville Games which later became the Paralympics. Under his supervision, the spinal injuries centre expanded to 200 beds and remains a centre of excellence for care of these patients today. CONCLUSIONS: The vision and determination of Prof. Guttmann in the care of spinal injuries patients revolutionised their care and established firm principles which are widely used today. He recognised the importance of bladder management but also the wider holistic care of his patients.