In 1917, at the age of 18, Ludwig Guttmann volunteered at a hospital and watched a young coal miner, who suffered a serious spinal injury and paralysis, wither away over a five-week period in isolation. Doctors could do nothing for him except encase him in plaster and watch him die. Six years later, Guttmann graduated from the University of Breslau in Poland in medicine, after which he took a position in Neurology and Neurosurgery, only because he could not find a placement in pediatrics, his first choice.
That decision was to have impact ripples that resonate powerfully today.
As the head of the National Spinal Injuries Center at Stoke Mandeville Hospital in Buckinghamshire, England, Dr Guttmann pursued a line of treatment novel at the time – rehabilitation of injured war veterans via sporting activities to build up not only their physical capacity, but also their mental strength. Likely recalling the demise of the young coal miner when he was 18, Guttmann believed that patients with such disabilities required a new form of treatment, a forward-thinking treatment, that would eventually prepare them for re-entry into society. As explained in this article:
Guttmann fundamentally disagreed with the commonly held medical view on a paraplegic patient’s future and felt it essential to restore hope and self-belief in his patients as well as practical re-training so when they were well enough to leave they could once more contribute to society. He achieved this firstly by changing the way they were treated – he had them moved regularly to avoid the build up of pressure sores and the possibility of urinary tract infections developing – and secondly by engaging them in physical and skill-based activities. Sports like Archery improved their mental wellbeing while learning new skills, such as woodwork, clock and watch repair and typing, would ensure they would be employable. If staff, or patients, on Ward X thought they were going to have an easy time, they were in for a shock.
Guttmann was less innovator and more revolutionary, a man who’s powerful belief in the ability of disabled patients to recover from tremendous physical disabilities to re-enter society led to an incredible transformation at the spinal injuries center. According to this article, Stoke Mandeville had 24 beds and 1 patient when Guttmann arrived, but within 6 months the center housed close to 50 patients, all receiving his obsessive care. Said one Dr. John Silver,
Essentially if they went anywhere else for care, the spinal injuries patients died. He exerted a total, obsessive control over all aspects of care at the hospital, whether it was him coming round in the middle of the night to make sure that the nurses had turned patients, or checking on the quality of the cleaners’ work or that of the food served on the wards. Everything was his responsibility. This was such an enormous contrast with consultants in other hospitals.
Inspired by the 1948 Olympic Games which were held in London, Guttmann held an archery contest on July 28, 1948, the day of the opening ceremonies of the London Olympics. A total of 16 disabled wheelchair-bound men and women came together representing two institutions: The Star and Garter Home in Richmond Surrey and Stoke Mandeville. (According to the Star and Garter site, their team won, not only in 1948, but also 1949.)
The archery contest was well publicized, for it was in the spirit of the Olympics, whose ideals of participation resonated with the disabled who yearned to participate and be included. Guttmann is quoted here as saying, “Small as it was, it was a demonstration to the public that competitive sport is not the prerogative of the able-bodied.”
And thus was born the Paralympic Movement.
If ever I did one good thing in my medical career it was to introduce sport into the treatment and rehabilitation programme of spinal cord sufferers and other severely disabled.
Dr. Ludwig Guttmann, in Scruton, ‘Stoke Mandeville, Road to Paralympics’. The Peterhouse Press, 1998