F- CLINICAL ASPECTS OF SPINAL CORD INJURIES
331
In special experiments in co-operation with Cunningham, Whitteridge & Wyndham
(1953) we studied heart output, venous pressure and muscle bloodflow. Records taken
at the height of a detrusor contraction of the bladder in a case below T6 showed a fall in
bloodflow in the calf and a rise in bloodflow in the forearm. In a patient with a lesion below
T6 on the left and Ty on the right, the blood flow through both forearm and calf was
found to fluctuate widely during distension of the bladder; the greater changes coincided
exactly with the peaks of the detrusor contraction with a rapid return towards normal as
soon as the detrusor contraction was over. If, however, observations were not made at
the height of the detrusor action, changes were found to be small (Fig. 146).
32
48
56
64
Minutes
80
FIG. 146. Bladder distension in patient (4). Lesion below T6 on left, Ty on right.
From above downwards, at the beginning of observations, blood pressure systolic and
diastolic, pulse rate, blood flow in calf, O——O> blood flow in forearm, •——•, bladder
pressure, bladder volume, skin temperatures from forehead, left hallux (L.T.i) and
right thumb (R.F.i). From Cunningham, Guttmann, Whitteridge and Wyndham (1953)
J. Physiol.,
121, 581.
Venous pressure was measured by means of a saline manometer connected to a
wide bore transfusion needle inserted into the anticubital vein. The patients lay flat
with the foot of the bed raised by foot blocks and the arms abducted at the shoulder. The
patients were allowed to reach a steady state in this position before venous pressure was
recorded, and the measurements were made in relation to the sternal angle. As shown in
Figs. 147 and 148 in complete lesions below Cy and Ti there was a sharp rise of venous
pressure to 7 and 14 cm H2O respectively during bladder distension and detrusor action.
