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subject of research in the past, and reference is made especially to Andre-Thomas'
monograph
Le Reflexe Pilomoteur
(1921) in which he described, in particular, a great
variety of pilomotor reflex disturbances in syringomyelia due either to increase or lack
of diencephalic excitability caused by complete or partial interruption of the diencephalic-
spinal pilomotor fibres or due to destruction or irritation of the lateral horn chain. Thomas
found no pilomotor disturbances in polio as in his view the infectious process is confined
to the anterior horns only. This is not in accordance with my own observations as far
as the function of the sweat glands is concerned. During the polio epidemic in 1932 in
Silesia, I found amongst 223 patients several cases where, in addition to the destruction
of the anterior horns, the intermedio-lateral horns were also affected resulting in disturb
ances of sudomotor function. In some patients, these disturbances—either hyper- or
hypohidrosis—were confined to the paralysed limbs, in others there were considerable
dissociations between the motor paralysis and the disturbances of sweating (Fig. 128).
One patient—a 23 year old woman with pregnancy of 8 months—with ascending motor
paralysis died from respiratory paralysis. The histological examination of the spinal cord
showed not only most severe destruction of the anterior horns throughout the whole
length of the cord but the lateral horns were also affected by the inflammatory process
(Guttmann, 1933).
In complete transverse lesions of the spinal cord, the paralysis below the level of the
lesion also involves the pilomotor system. In cervical and Ti/T2 transections, the
pilomotor paralysis affects the whole body, including both upper limbs. In lesions below
T5, pilomotor function in the upper limbs and chest is preserved, and the lower the
thoracic lesion the more the areas of the trunk showing pilomotor response to cooling
and other stimulation above the cord lesion. In fact, in complete lesions with segmental
supralesionary hyperreflexia, increased pilomotor response may be part of the autonomic
hyperactivity in the affected segmental dermatomes. In complete lesions below L2,
there is no paralysis of the pilomotor function.
Once the stage of spinal shock has subsided and the exaggerated reflex function of
the isolated cord has developed, the spinal pilomotor reflex is one of the components of
the mass reflex and can be elicited in the skin areas below the level of the lesion either
alone or in combination with flexion contractions of the spastic legs, detrusor contraction
of the bladder or other visceral activity in the paralysed part of the body.
Sudomotor function
Sweat glands activity, apart from the vasomotor control, represents the most important
mechanism for maintaining homeothermia in man by regulating heat loss. This function
of the sweat glands depends on the integrative control of the various afferent and efferent
components of the peripheral and central nervous system, amongst which the spinal cord,
anterior and posterior roots and the pre- and post-ganglionic innervation play their part.
Thermoregulatory as well as reflex disturbances of the sudomotor system can be readily
demonstrated in man by applying dye methods amongst which the Starch-Iodine
Method (Minor, 1927) and the Quinizarin Compound (Guttmann, 1937) have proved the
most satisfactory.
