Urinary paraplegia and William Withey Gull

In 1833, Edward Stanley described the autopsy findings in seven men with paraplegia but no visible spinal cord abnormality. All had upper urinary tract infections. Stanley suggested that a nerve-transmitted input from the kidneys could suppress function in the spinal cord, causing paralysis. Others-principally Leroy d'Etiolles (1856) and Brown-Séquard (1859-1862)-expanded the concept to account for otherwise unexplained limb weakness (urinary or reflex paraplegia), and widened the range of culprit anatomical sites. Such interpretations continued until into the late-nineteenth century. In 1861, William Gull, long interested in paraplegia, attacked the concept, arguing that it depended on failure to examine affected spinal cords microscopically. He hinted that catheterization might have played a part in the phenomenon. With increasing knowledge of spinal cord histopathology and awareness of the basis of suppuration and the need for sterile techniques, mention of urinary paraplegia disappeared gradually over the course of the nineteenth century and the disease as an entity ceased to exist by 1900.