April 20, 1915, the patient was found to be a robust, somewhat microencephalic slowly cerebrating subject. Total flaccid paralysis of legs; right knee-jerk slightly exaggerated; no plantar response of any sort was obtainable. Right leg entirely anesthetic; left leg and both arms showed a diminution of sensibility; suggestion of glove and stocking anesthesia; trophic changes absent. The scar of the healed bullet-wound lay over the trunk of the left sciatic nerve.
It seems that the man’s companion had both his legs blown off at the time the shell burst. It is questionable whether the paraplegic patient actually saw the legs blown off, or merely heard about the accident. Another psychic feature lay in the fact that the patient had a paralyzed sister—a possible financial burden.
April 30, nitrous acid anesthesia. During the temporary rigidity, the legs were found to stiffen slightly; the legs were flexed. Upon the return of consciousness, the patient was told that the legs had moved during anesthesia, and was asked to place them in a more convenient position. The thighs moved slightly, and throughout the day movements were encouraged against resistance.
The next day he was gradually raised to the vertical position and supported upright. But at this stage he had become mentally resistant and resentful. During the day the upright position was at intervals resumed, and the patient was made to walk between two attendants. The next day he walked alone and his mental resistance had broken down. There was no longer any evidence of exhaustion and effort in the movements, and the patient began to take pleasure in his recovery.
Improvement was progressive. A pronounced hysterical element persisted, encouraged by the perpetual attentions of visitors. When discharged, there was a slight hemi-anesthesia throughout the right side, and a doubtful patch of anesthesia on the dorsum of the foot, sole, and plantar surface of the heel.
Shell-shock; burial; flexion of spine: Paraplegia.
Case 237. (Elliot, December, 1914.)
A reservist, 34, formerly army instructor in gymnastics, a member of the 1st Battalion King’s Royal Rifles, was subject to injury from the bursting of a “Black Maria” on his trench. He was sitting with bent back in his shelter, with legs fully extended. He was in a small dug-out, a recess excavated under the earth backward from a narrow trench and not timbered. The “Black Maria” burst and covered him up to the chin in a heavy clay soil. After building up the breach twenty minutes later, his comrades dug him out.
He had received on his body the violent impact of the mass of earth pushed laterally from the crater excavated by the bursting of the shell. Accordingly his vertebral column was forcibly flexed, its ligaments were stretched, and hemorrhages were produced in the great muscles of the back. As the twelfth thoracic vertebra is the weakest spot in the spine, the roots of the cauda equina opposite this weak spot were probably injured. Such accidents are met in mines.