F-CLINICAL ASPECTS OF SPINAL CORD INJURIES
327
between the spinal cord and the cerebral regulatory centres are not completely inter
rupted, the facilitatory central impulses may outweigh the inhibitory ones and cause
urgency of micturition with varying degrees of incontinence. As in complete lesions the
symptoms of autonomic hyperreflexia, especially those of the cardio-vascular system, can
be elicited in relationship to the size and expansibility of the bladder. Fig. 142 demon
strates the relationship of cystometrogram to cystography in a case of incomplete lesion
of Cy where the increase of bladder pressure only started at 450 ccs eliciting bradycardia
and hypertension reaching its maximum at bladder volume of 600 ccs.
Effects of bladder distension and vesical hyperactivity on somatic and
autonomic systems
The heightened reflex activity of the automatic bladder has its repercussions on both
somatic and autonomic mechanisms both below and above the transverse lesions. The
volleys of afferent impulses from the distended bladder wall and contracting detrusor
may radiate unrestrainedly along the whole reflexogenic zone of the isolated cord. This
in turn may elicit widespread reflex responses of skeletal muscles, resulting in flexor or
extensor spasms of the legs, involving in higher thoracic lesions also the abdominal,
intercostal and trunk muscles and in cervical lesions even muscles of the upper limbs
(see Fig. 106).
Of special interest are the widespread reflex responses of autonomic mechanisms set
up by distension of the bladder and vesical hyperactivity in the spinal man. It was shown
by Carmichael, Doupe & McSwiney (1939) that distension of the duodenum in non-
paraplegic healthy men produced vasoconstriction, more marked in the toes than in the
ringers, and the same was found by Stiirup (1940) following distension of the oesophagus.
Circumscribed disturbances of sweating, corresponding to the segmented distribution
of the gall-bladder, have been described as due to a viscero-sudoral reflex (Guttmann,
1938). In one of the cases published a change of functional state of sweat glands activity
was studied in relation to a severe gall-bladder attack. While the sweat test carried out
immediately following the attack showed an almost complete anhidrosis in the distri
bution of the yth and 8th thoracic dermatomes on the right side, a relative hyperhidrosis
was found in the same area as compared with the left side in tests before and three days
after the attack when the patient had only little discomfort.
Sherrington (1899) described a sharp rise of blood pressure following distension of the
gall-bladder in a spinal cat and Watkins (1938) and Talaat (1938) reported a rise of
blood pressure in animal experiments when the bladder pressure was raised. Head &
Riddoch (1917), in their classical paper on reflex responses in traumatic paraplegic
soldiers of the First World War, described the effects of bladder activity on sweating,
which was also previously described by Bowley (1890) in a case of traumatic tetraplegia.
Andre-Thomas (1921) published his studies on pilo-erection responses made during the
First World War on paraplegic soldiers and demonstrated that distinct reflex responses
could be elicited by stimulation above and below the lesion of the spinal cord (see
chapter on the Pilomotor system).
In 1944, during my early cystometrographic studies on traumatic paraplegics of the
