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Abstract

Pressure sores have been known since antiquity; their association with the disease of nervous system was first suggested in 1593 by Fabricius, who implicated severance of peripheral nerves. There were a series of accounts by Bright (1821) and Brodie (1836) who described their evolution in patients with traumatic injuries of the spinal cord. However it is to Charcot (1877) that we owe the first scientific analysis of the causation of pressure sores, in a very full description of the pathogenesis of sores in diseases of the spinal cord and of the nervous system. His work was seminal, and as it has either been ignored or misquoted it is worthwhile studying his concepts in detail. He stressed that the causation of the sore in cerebral and spinal cases was the same, that anaesthesia of the paralysed part was not the sole cause, and that the patient with incomplete lesions also got sores. He recognised that rapid atrophy of the tissues contributed, as did immobility. He also recognised the role of pressure but considered it secondary. He tried to alleviate this by turning the patient regularly. He stressed that sores could appear in two days and carried an ominous prognosis, and indeed called them ‘ominous’ sores.

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References

  1. Baker, J. H. E., Silver, J. R. and Tudway, A. J. C. (1984). Late complications of pressure sores. Care, Science and Practice, 3, 56–59Google Scholar
  2. Breithaupt, D. J., Jousse, A. T. and Wynne-Jones, M. (1961). Late cause of death and life expectancy in paraplegia. Can. Med. Assoc. J., 85, 73–77PubMedPubMedCentralGoogle Scholar
  3. Bright, R. (1821). Report of Medical Cases, London, pp. 380–432Google Scholar
  4. Brodie, B. (1836). Medic. Chirug. Transactions, 148Google Scholar
  5. Charcot, J.-M. (1877). On Diseases of the Nervous System. Translated by Sigerson, G., New Sydenham Society, pp. 63, 126Google Scholar
  6. Cook, J. B. (1961). Scientific aspects of neurology. In Garland, H. (ed.), Leeds Neurological Sciences Colloquium 1959–60, Churchill-Livingstone, Edinburgh, Chapter 19, pp. 241–248Google Scholar
  7. Creek, G., Moore, M., Oliver, M., Salisbury, V., Silver, J. R. and Zarb, G. (1987). Personal and social implications of spinal cord injury: A retrospective study. Thames Polytechnic, p. 220Google Scholar
  8. Fabricius, Hildanus (1593). De gangraena etsphacelo tractatus methodicus, LeydenGoogle Scholar
  9. Geisler, W. O., Jousse, A. T. and Wynne-Jones, M. (1977). Survival in traumatic transverse myelitis. Paraplegia, 14, 262–275PubMedCrossRefGoogle Scholar
  10. Geisler, W. O., Jousse, A. T., Wynne-Jones, M. and Breithaupt, D. J. (1983). Survival in traumatic spinal cord injury. Paraplegia, 21, 364–373PubMedCrossRefGoogle Scholar
  11. Guttmann, L. (1953). The treatment and rehabilitation of patients with injuries of the spinal cord. In Cope, Z. (ed.), Medical History of the Second World War, Surgery. HMSO, London, vol. 2, 422–516Google Scholar
  12. Guttmann, L. (1976). In Spinal Cord Injuries, Comprehensive Management and Research. Blackwell Scientific Publications, Oxford, pp. 512–543Google Scholar
  13. Holdsworth, F. (1963). Early orthopaedic treatment of patients with spinal injuries. n Harris, P. (ed.), Proc. Symp. Spinal Injuries, R. Coll. Surg., Edinburgh, pp. 93–101 and 160–162Google Scholar
  14. Jousse, A. T., Wynne-Jones, M. and Breithaupt, D. J. (1968). A follow up study of life expectancy and mortality in traumatic transverse myelitis. Can. Med. Assoc. J., 98, 770–772PubMedPubMedCentralGoogle Scholar
  15. Munro, D. (1945). The treatment of patients with injuries of the spinal cord and cauda equina preliminary to making them ambulatory. Clinics, 4, 448–474Google Scholar
  16. Munro, D. (1947). The rehabilitation of patients totally paralysed below the waist with special reference to making them ambulatory and capable of earning their living. III. Tidal drainage, cystometry and bladder training. New Eng. J. Med., 236, 223–235PubMedCrossRefGoogle Scholar
  17. Ravichandran, G. and Silver, J. R. (1982). Missed injuries of the spinal cord. Br. Med. J., 284, 953–960CrossRefGoogle Scholar
  18. Richardson, R. R. and Meyer, P. R. (1981). Prevalence and incidence of pressure sores in acute spinal cord injuries. Paraplegia, 19, 235–247PubMedCrossRefGoogle Scholar
  19. Silver, J. R., Morris, W. R. and Otfinowski, J. S. (1980). Associated injuries in patients with spinal cord injury. Injury, 12, 219–224PubMedCrossRefGoogle Scholar
  20. Silver, J. R. (1975). Pressure sores, management of complications. Modern Geriatrics, 5, 6–16Google Scholar
  21. Silver, J. R. and Gibbon, N. O. K. (1968). Prognosis in tetraplegia. Br. Med. J., 4, 79–83PubMedPubMedCentralCrossRefGoogle Scholar
  22. Silver, J. R., Morris, W. R. and Otfinowski, J. S. (1980). Associated injuries in patients with spinal cord injury. Injury, 12, 219–224PubMedCrossRefGoogle Scholar
  23. Thompson Walker, J. (1917). Hunterian lecture on the bladder in gunshot and other injuries of the spinal cord. Lancet, 173–179Google Scholar
  24. Thompson Walker, J. (1937). The treatment of the bladder in spinal injuries in the war. Br. J. Urol, 9, 217–230CrossRefGoogle Scholar
  25. Thyagarajan, C. and Silver, J. R. (1984). Aetiology of pressure sores in patients with spinal cord injury. Br. Med. J., 289, 1487–1490CrossRefGoogle Scholar
  26. Tribe, C. R. and Silver, J. R. (1969). In Renal Failure in Praplegia. Pitman Medical, London, pp. 54–89Google Scholar

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© The editor and contributors 1990

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  • J. R. Silver

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