He was wounded in the right buttock with a shrapnel bullet about the end of September, 1914. He went back to his regiment two months later and had shared in a number of actions up to the time of his evacuation. He said he had been very tired for several weeks, and had finally been sent to the physician. There were pains in the kidney region and in the head, especially on the right side. The head felt empty. He could not sleep, but did not dream. Ideas were not distinct. Memory had become impaired. He could not keep his accounts right, and was afraid something might go wrong.
There was no pain or nervous or reflex disorder of any sort except for the knee-jerks and Achilles jerks (see below). A special examination proved complete normality of eyes. There was a slight hesitation in words, but no dysarthria. There was a slight tremor of the tongue and fingers.
As to the tendon reflexes, April 9, on waking, the knee-jerks were absent, but later in the day gradually came in evidence again. The Achilles jerks were also absent at first, but could be obtained after a prolonged examination and after percussion of the calf. In the afternoon, after exercise, the knee-jerks and Achilles jerks were easily demonstrable. The left Achilles jerk was always a little weaker than the right. Massage brought these jerks out to virtual normality. April 10 and thereafter, similar findings; percussion of the muscular masses of the thighs and calves always brought out the reflexes.
Lumbar puncture yielded a clear fluid with hyperalbuminosis, 20 cells per c.mm. (lymphocytes and mononuclear cells 95 per cent) and a positive W. R. Iodide of mercury treatment was given April 18.
April 23, the patient went into a coma, with trismus, stiff neck, Kernig’s sign, sluggish pupils, incontinence. He was transferred to a special hospital, showed on lumbar puncture, April 23, 85 per cent polynuclear leucocytes, and died April 27. The autopsy showed a yellowish, quasidiffluent softening of the size of a small egg in the first occipital gyrus on the right side. The authors comment on the fact that the only objective sign in this case was the variable tendon reflexes of the lower extremities, “l’unique cri de souffrance des centres nerveux.”
Early recovery from a spinal cord lesion.
Case 111. (Mendelssohn, January, 1916.)
Mendelssohn reports a soldier, who was sent to a Russian hospital, April 12, 1915, with a diagnosis of chronic appendicitis. Operated on next day, the patient appeared to be passing through a normal convalescence, when ten days later, he had an intense headache and some trouble in vision, which disappeared the next day, only to be followed, two days later, by the patient’s complaint that he could no longer urinate or rise from bed.
In fact, Mendelssohn found a complete flaccid paraplegia with urinary retention, without fever or pain. Knee-jerks and Achilles jerks were absent, and there was a slight extension of the great toe on plantar stimulation. There was disorder of sensation, with heat sensibility abolished, painful points poorly localized, and position sense poor. Electric reactions normal. Pain on pressure in and about the lumbar vertebral region. Cerebrospinal fluid showed lymphocytosis and an excessive albuminosis.
This paraplegia lasted six weeks. At the end of May, the patient began to be able to move his toes and to lift his heel. Improvement was gradual and progressive. Early in June he could walk if supported. The weak knee-jerk then began to reappear and the urinary retention gradually disappeared.