SHELL-SHOCK PSEUDOTABES (non-syphilitic, serum W. R. positive). Improvement. Case from Pitres and Marchand of Bordeaux.
Case N. Innkeeper B., 36, a shell-shock and burial victim June 20, 1915, was looked on by a number of physicians as a case of genuine tabes.
Even eight months after the episode, he still showed (when observed by Pitres and Marchand, February 3, 1916) absence of knee-jerks and Achilles jerks, a slight swaying in the Romberg position, pupils sluggish to light, incoordination, delayed sensations. There was also a history of pains in the legs, compared by the patient to those of sciatica. These pains came in crises, the longest of which had lasted 30 hours.
It seems that this soldier’s troubles began the day after his shock with a feeling of swollen feet and of cotton wool under them. He stayed on service, however, walking with increasing difficulty.
At the time of his evacuation, July 10, he could walk with great difficulty. “Strips of lead were between his legs.” He could hardly control movements in the dark, or descend stairs. Often his legs would bend under him. Vesical function sluggish.
After a few months the patient could walk better. On February, 1916, he walked thrusting his legs forward trembling, and dragging toes a little. He could not support himself on either leg. Jerkiness and incoordination in extension or flexion of leg on thigh.
The muscular weakness was decidedly against tabes or at all events a pure tabes. The incoordination proved to be due, not to loss of position sense (which was intact) but to unsteady muscular contractions. Deep sensibility was intact.
There were no mental symptoms. There was a slight hesitation in speech and doubling of syllables, but nothing demonstrable with test phrases.
The serum W. R. was positive. Syphilis denied.
1. What is the cause of these phenomena? Pitres and Marchand lean to the hypothesis of slight internal traumatism. They believe that there is either (a) slight internal hemorrhage in the nervous system, or possibly (b) what they call “nerve cell contusion,” or perhaps (c) caisson-disease-like phenomena from aerial decompression. Some authors incriminate (d) the gases. It has been reported by certain French authors that shortly after shell-shock injury or burial there is a pleocytosis in the spinal fluid as well as evidence of hemorrhage. The pleocytosis is said to last only a short time; hence when patient arrives at a base hospital lumbar puncture usually discloses nothing.