Paralysis due to injury of the spine was first described in the Edwin Smith Papyrus, which dates back 3000 years to Ancient Egypt. It was described as an unsurvivable injury. From the time of Hippocrates up until the Renaissance the primary treatment was traction and reduction of a fracture or dislocation, these injuries were not described as survivable. Galen discovered that the severing of the spinal cord was the action which caused paralysis in the cases of spinal injuries. During the Renaissance the spinal cord and nerves were studied and better understood. Intricate drawings of the central nervous system by such artists as Leonardo DeVinci increased our understanding of spinal cord injuries. The earliest evidence of wheelchairs came from 6th century China, and mimicked the recently invented wheelbarrow.

During this a surgery developed in the 7th century which removed portions of shattered vertebrae was used to treat a spinal cord injury. During the Renaissance, surgeon Ambroise Paré was known to be routinely using and recommending the laminectomy for spinal injuries. The laminectomy removed part of the injured vertebrae to relieve pressure on the spinal cord. The injury was still considered universally fatal. Surgeries as a whole held a high mortality rate at the time, and if paralysis continued this was considered a fatal injury. It was around this period that wheelchairs began to look less like carts or litters and more like what we would consider a wheelchair. Most were three wheeled and either propelled by an assistant or by a hand crank mechanism. The first evidence of a manual wheelchair which the user can control dates back to 1655 when a young, paralyzed Flemish watchmaker named Stephan Farfler invented a three wheeled chair he could control with a hand cranked gear system. Phillip II of Spain was also known to be a wheelchair user as of 1595.

Paralysis in and of itself was not uncommon, was sometimes survivable, and was generally poorly defined. For example the terms general paresis, spinal paralysis, infantile paralysis, teething fever, palsy, lameness, paraplegia, neuralgia, and even hysteria as recently as the mid-19th century might all refer to the disease we now know as polio. Paralysis caused by disease or disorder which did not affect sensation, the breathing muscles, or the bladder and bowel, were likely to be survivable by the late 18th century, and have been variably seen as survivable throughout history.

Spinal cord injuries were separate from this. By the turn of the 19th century the laminectomy could very occasionally restore sensation. If full sensation and most movement was restored there was a possibility of survival. Surgeries were still performed without anesthesia or antiseptic protocols and although understanding of the anatomy of the spine and central nervous system were better, the injury was still universally fatal outside a handful of cases where sensation and movement were restored by surgically relieving pressure from the spinal cord. The short answer is that from antiquity until the 1930's an injury to the spinal cord was considered an injury not to be treated.

In the early 19th century there were generally two schools of thought, exemplified by two British surgeons, Astley Cooper and Charles Bell. Astley was a firm believer in the laminectomy and advocated surgical treatment for these injuries. Bell pointed out that paralysis was caused at the moment of injury, so most of the time a laminectomy only hastened death. He also pointed out that death was often attributed to renal failure related to paralysis of the bladder. Bell primarily advocated immobilization and palliative care. Neither saw the injury as survivable.

In 1805 Lord Nelson died of a spinal injury during the battle of Trafalgar, he was told by the ship's surgeon that nothing could be done, a true, if tragic statement. In 1881 American President James A. Garfield died of a similar injury, and was similarly informed of his fate. The same year, push rims made the first self propelled modern wheelchairs possible.

During the 19th century surgical practice improved, particularly with the use of anesthesia and understanding of germ theory. Throughout this period the understanding of the anatomy of the spinal cord was better understood, as was surgical technique relating to surgery on the nervous system. The mechanisms which generally caused death were better understood as well. Death was generally defined as being caused by damage to the kidneys and infections of the skin, bladder, or respiratory system.

In 1867 American physician Dr. John Ashhurst published a study of 400 cases of paralysis due to spinal injury, most included autopsy notes, showing that the injury was still fatal unless a great deal of sensation and movement was restored. Some of the patients described lived for months, a few lived over a year, but the vast majority died within the first month after injury. Ashhurst wrote "as a rule, the higher is the part injured, the gloomier is the prognosis, and the more rapidly is death apt to supervene."

By the end of the 19th century, several German physicians, primarily William Wagner and Paul Stolper, were advocating treating the symptoms which most often caused death, namely infections and renal failure. Wagner and Stolper advocated treatments involving immobilization until the fracture healed, catheterization, turning to prevent pressure sores, and mobilization once the spine has healed. Bladder management and keeping incontinent patients clean and dry were seen as the best way to lower morbidity. There is evidence that due to these treatments some of Wagner's patients lived long enough to return home, though their life expectancies were shortened. The textbook Wagner and Stolper produced in 1898 and by Theodor Kocher in 1896 became the standard.

The first dedicated spinal units were developed in Britain, France, and Germany during the First World War. For the first time many doctors advocated attempting to get patients home, but many healthcare workers still held a defeatist attitude towards these injuries. In hospital regular turning and catheterization were performed, and physical therapy was advocated but death rates were still awfully high. In 1918 American surgeon Harvey Cushing stated that death rates within the first month of injury was still around 80%, all reports of this time back up this statistic and agree that death rates were near 100% within the first few years after injury. Survivable injuries were still almost universally incomplete lesions.

At this point wheelchairs were still wooden, but were manual and self propelled. Lighter and foldable wheelchairs would be developed between the 1930s and the 1950s, the electric wheelchair wouldn't be used until later. In the 1930s paralysis of the respiratory muscles became no longer universally fatal when the respirator or "iron lung" was developed for the treatment of polio patients.

Until the turn of the twentieth century, high death rates were due to a lack of medical knowledge, and a lack of ability to treat such injuries. During and after the First World War, many physicians felt that the high death rates were partially due to some physicians and health care workers feeling not that the injury could not be treated, but that a life with paralysis was one not worth living.

With the advent of antibiotics, and the work of physicians like Dr. Ludwig Guttmann the fate of spinal cord injury patients during and after the Second World War was worlds apart from what had come before. Today approximatly 75% of spinal injuries are survivable, a near complete reversal from the statistics 100 years ago.

https://archive.org/details/b21308664

https://pmj.bmj.com/content/81/952/108

https://archive.org/details/injuriesofspinew00ashh/page/n5

https://archive.org/details/b22329183/page/n1

https://archive.org/stream/b28056632/b28056632_djvu.txt

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2031949/

https://www.thoughtco.com/history-of-the-wheelchair-1992670

http://mentalfloss.com/article/20768/who-invented-wheelchair