Shrapnel wound of skull; focal canities over wound; shell-shock and shrapnel wound of right leg. Head tremors and contractions, changing in relation to posture; glove anesthesia and local anesthesia of trunk.
Case 212. (Arinstein, September, 1915.)
A Russian private, 24, was wounded twice: once in the head by a bullet, and at another time by a bit of shrapnel that imbedded itself in the skull. The hair over the injured spot became gray.
Later, September 16, 1915, the soldier was subjected to shell-shock, and at the same time wounded by shrapnel fragment in the right leg (operated next day).
Upon examination at Petrograd, the hearing was found diminished and the eardrum was pulled in. At first the patient could not speak or open his eyes, and made incessant lateral movements of the head, jerking backwards and to the right. The right half of the face gave convulsive movements, which began at the lip and spread upwards. During sleep, there was an entire cessation of these head shakings and jerks. In the lying posture, the head shook at a rate of 100 to 120 per minute. The jerking movements became more marked when the patient sat up or walked. He carried his head bent toward the right shoulder. When he sat down, the side-shaking movements disappeared, only to reappear when he lay down. The swallowing reflexes were absent. The sensitiveness to touch, pain, and temperature was lost in the upper part of the trunk including the neck, to the level of the tenth dorsal vertebra. There was anesthesia of the arms as far as the elbow on the right, and as far as the shoulder on the left. The mucosae of the mouth were anesthetic. Dermatographia was strongly marked.
Shell explosion; burial: Hemiplegia, probably organic.
Case 213. (Marie and Levy, January, 1917.)
A soldier was blown up by a shell and then buried at Vaux, March 29, 1916, and entered the Salpêtrière, July, 1916, with a right-sided hemiplegia and contracture without evidence of wound. He remembered nothing for the first fortnight after the trauma. When he came to himself, he was paralyzed and was unable to say more than a few words, but at the end of a month his aphasia ceased and he began to walk.