•210 THE SURGICAL PHYSIOLOGY 



surgical bearing. We want to look at them in 

 relation to the physiology of the spinal cord. 



Both in man and in animals, and particularly in 

 monkeys, a transverse injury to the cord leads to 

 the phenomenon known as spinal shock. All the 

 reflex functions are severely depressed, and there is 

 transient paralysis and anaesthesia. Sherrington has 

 shown in animals that a transection, e.g., in the 

 upper dorsal region, causes spinal shock only distal 

 to the lesion ; the cervical cord is normal. If after 

 recovery has occurred a second section is made in 

 the mid-dorsal region, no spinal shock is produced. 

 Evidently it was due to the withdrawal of impulses 

 running downwards from the brain-stem, probably 

 from the region of Deiter's nucleus, because tran- 

 section of the upper pons or mesencephalon does not 

 cause spinal shock. 



A total transection of the cord in man, not in 

 animals, affects profoundly the functions of the 

 segments below the injury, and either from the first 

 or after the lapse of a little time they lose their reflex 

 functions, the bladder and rectum and their sphincters 

 become paralysed, and the effect is much the same 

 as it would have been if the isolated portion of the 

 cord had been removed in toto. In animals, the 

 reflex functions persist. 



Considerable difficulty may be experienced for a 

 day or two in deciding whether a patient is suffering 

 from a complete division of the cord due to the nip 

 at the moment of fracturing the spine, or whether 

 the symptoms are due merely to concussion. In 

 the latter case a few days' rest will effect a cure. 



