Spinal Cord Casualties

To the Editor.  —The trouble with contemporary medicine is that there are more answers than questions. Although unyielding of satisfying answers, a result of the immense labor detailed in Kunin's report in the February issue Arch Intern Med127:285-287, 1971) on spinal cord casualties is that neglected questions are reemphasized. The association of pyelonephritic contracted kidneys with hypertension was known to Lohlein,¹ but not until Butler's report² of the 1930's was it satisfactorily shown that pyelonephritis could cause hypertension prior to renal insufficiency. This sequence occurred in two thirds of a series of children, one of whom provided an affirmative answer to Longcope's suggestion³ that hypertension could result from calculous pyelonephritis confined to a single kidney.Neurogenic uropathy may result from any lesion interrupting either the vesical reflex arc or its central inhibition. Patients thus disabled from whatever cause immediately or ultimately incur risk from pyelonephritis.