The hemiplegia was spastic. There was pronounced contracture. The arm was extended, hand open, fingers stretched. Finger movements were diminished, as well as extension of the wrist, but the arm was otherwise normal. The leg was not so stiff. The great toe was in a state of continuous extension. The toes could not be moved, and the foot scarcely; but the leg could be strongly flexed and extended on the thigh. The tendon reflexes of the right side were more lively than on the left. Cloniform movements followed tapping the patellar tendon on the right side, and a patellar clonus and ankle clonus could also be demonstrated. Plantar reflex, flexor on the right. Distinct adduction of the foot. Slight disturbance of tactile sensibility in the paralyzed limbs; marked disorder of position sense and gross disturbance of stereognostic sense. Moderate dysarthria.
Ten months after the traumatism, the hemiplegia and spastic walk remained. The upper limb was now carried in extension back of the body, with hand supinated, fingers sometimes in extension, sometimes in flexion, index finger separately from the others. Finger movements difficult and shoulder movements limited. The leg, however, was almost normal except that the toes could not be moved. The tendon reflexes were more lively and cloniform on the right, but there was no longer patellar or ankle clonus. Stereognosis slow, but finger movements were naturally difficult. W. R. of blood, negative. Probably this is an organic case.
Blown up by a shell; no skin or bone lesion: Mixture of organic (e.g., lost knee-jerks) and functional (e.g., urinary retention) disorders.
Case 214. (Claude and Lhermitte, October, 1915.)
A man, 38, was blown up in a trench without sustaining skin or skeletal lesions, April 5, 1915. He lost consciousness for a half hour and, coming to, found a crural paraplegia and urinary retention. Examined July 24, in addition to the paraplegia were found tactile and algesic hypesthesia of the legs with preservation of deep sensibility. Pains were felt in the legs, especially in the hips. The knee-jerks were abolished; the Achilles jerks were preserved, as well as the flexor plantar reflexes and somewhat weakened cremasteric and abdominal reflexes. Micturition was difficult. Constipation. Slight paresis of left arm. Lumbar puncture, July 28, yielded a clear fluid of normal tension without chemical or cytological changes.
The sphincter disorders gradually disappeared. The knee-jerks reappeared in a weakened form August 31. The legs could, at the time of report, be moved somewhat, though not above the level of the bed.
We here deal, presumably, with a mild form of concussion of the spinal cord, in which, however, some of the transient symptoms are very possibly merely functional in origin.
Re complicated pictures of organic and functional nature, some experimental work has been carried out. Mairet and Durante set off explosives, such as melinite, at a distance of 1 to 1.5 metres, near rabbits. Some died at intervals from an hour to thirteen days; others lived. Pulmonary apoplexy was found in the cases dying early. Spinal cord and root hemorrhages, hemorrhages in the cortical and bulbar gray, perivascular and ependymal hemorrhages were found, always small and without diffusion, suggesting rupture by rapid decompression following the first wave of aerial compression. The functional effects are thought to be brought about through the anemia of the areas supplied by the ruptured vessels. Russca of Berne got similar results and notes direct and contrecoup brain lesions, tympanic perforations, intra- and extra-ocular hemorrhages, thoracic, cardiac, and splenic hemorrhages, ruptures of kidney, stomach, intestine, and diaphragm. As in the work of Mairet and Durante, the lung proved the most sensitive organ. (Compare also the human case of Sencert [[Case 201]].) Some experiments with fishes yielded lesions of the swimming bladder. Persalite and other explosives were used.