In 76 consecutive patients with spinal cord compression the process of diagnosis and referral was investigated. This investigation was carried out at the time of admission to the neurosurgical unit when it was possible to obtain fresh information about each patient's pre-admission management. All the patients had been referred from District General Hospitals and 71 had previously consulted their general practitioners. Sixty-two per cent took over a week from the time they first saw their own doctor to reach the referring hospital; after reaching hospital 47% of patients waited a week or more before they were referred to a neurosurgeon. During the process of referral, the proportion of patients able to walk unaided and control their sphincters fell from 68% to 10% while the proportion with complete cord lesions rose from 1.5% to 28%. In 48% of cases there had been delays in diagnosis and referral which appeared avoidable. The reasons for these delays and their effect on the eventual outcome are assessed.