F- CLINICAL ASPECTS OF SPINAL CORD INJURIES
471
pressure above 180-190 systolic and 115 diastolic during the first or second stages of
labour would appear to be an indication for expediting delivery by episiotomy, forceps
or even Caesarean section, in order to avoid the danger of cerebral haemorrhages. In this
respect, a case of complete cord lesion below T5 described by Jung & Schmidt (1962) is
very significant. This woman developed intermittent hypertension with blood pressure
rising to 230/1 lommHg with every uterine contraction. These hypertensive attacks
were associated with 'dramatic convulsions and profound headaches'. Very soon, the
intermittent rises ofblood pressure were replaced by a slow, continuing rise to 230/i45mm
associated with vomiting. Although immediate Caesarean section was performed and a
healthy boy was delivered, the mother developed a cerebral haemorrhage, which left her
with a paralysis of the left arm, paralysis of ocular movements and a left facial paralysis.
The authors explained the intermittent hypertensive attacks, which started following rup
ture of the membranes, when the child's head was just above the ischial spines, as a viscero-
spinal reflex response, in confirmation of Guttmann and Whitteridge's investigations
on the effect of bladder distension on autonomic mechanisms, while the sustained rise of
blood pressure was thought to be due to an acute rise in intra-cranial pressure due to
hypertensive haemorrhage from a post-traumatic aneurysm. However, it may be stressed
that cerebral haemorrhages as a result of intermittent hypertensive attacks in those high
lesions due to excessive visceral activity may occur without the presence of cerebral
aneurysms or other vascular abnormalities.
Recently, Goller & Paeslack (1970) reporting on cases of traumatic paraplegic women,
who were pregnant at the time of injury and later gave birth to abnormal children,
raised the question of whether or not the percentage of abnormal children born to trau
matic paraplegic women was higher than that found in women who sustained other
types of injuries during pregnancy. Only comparative statistics on a large scale would
clarify this problem.
The married life of paraplegics and tetraplegics
One would expect that a disablement of a magnitude such as paraplegia or tetraplegia
would set up in its wake difficult problems in the domestic resettlement of these severely
disabled people, particularly in their marital adjustment. This is doubtless true to some
extent. Nevertheless, it is an undeniable fact, that many subjects who were already married
at the time of their spinal cord injury or disease, have continued their married life success
fully for many years, and others have started their married life after having become
paraplegics or tetraplegics.
Major statistical surveys on the marital lives of a particular number of paraplegics
and tetraplegics are scanty. In 1962, Comarr of the Spinal Unit at Long Beach Veterans'
Hospital, U.S.A., published a survey on 859 paraplegic and tetraplegic veterans of the
U.S. Army and more recently Deyoe (1972) published a survey on 219 veterans of the
U.S. Army.
In 1964 a statistical survey on the marital status of 1,505 living traumatic paraplegics
and tetraplegics of marriageable age, treated at Stoke Mandeville was published
