A private, 26 years old, had 11 months’ service and one month’s service in France. He arrived at a base hospital the day after his shock. Concussion had caused the dug-out in which he was standing to collapse. A beam struck him on the left side of the face, and pinned him to the ground on his right side. A piece of iron fell on the left side of his back, and his right leg was pinned by a cross beam on the back of his thigh. He was dazed by the shock; was released and was able to walk, but complained of a pain in the right groin and a giving-way of the right knee. The medical officer arrived about an hour later. A numbness, or state of no feeling, in the right thigh appeared, and increased to the point of total analgesia to the level of the upper margin of the patella save for a narrow strip in the mid-line on the posterior aspect of the leg. The only area of complete anesthesia and algesia was on the outside of the lower half of the leg.
According to the patient, it seems that about three years before, he had been buried four feet deep in a brick yard, beneath a heap of clay. He had felt it most in the right leg, but the thigh had been merely stiff and sore, and not numb. The patient admitted that the present accident immediately reminded him of his previous experience. There were no tremors or sensory disorders in the face, arms, chest, back, or abdomen. There was diminished sensibility to cotton wool of the left buttock (across which a plank had fallen), and there was a degree of hypalgesia of the buttock. The right thigh showed a degree of thermanalgesia and slight loss of vibratory sense. The corneal and conjunctival reflexes were diminished, and the knee-jerk was unobtainable on the right side. Three days later, there was a marked improvement with almost complete return to normal, whereupon the patient was sent to a convalescent camp.
Emotional subject, ALWAYS WEAK IN LEGS; shell explosion; wound of back: PARAPARESIS.
Case 288. (Dejerine, February, 1915.)
A Lieutenant, 25, was wounded at Arras about 10 a.m. October 20, 1914, just as he was leaning on another officer’s shoulder looking at a card in a chateau room. A shell burst in the court yard. A fragment came in the window, struck him in the back and pushed him forward, whereupon he felt pain in the back and a severe dyspnea, due to the gas from the shell. He lost consciousness several times and the dyspnea lasted for about two hours. When he was picked up he could not walk.
He was carried on a stretcher to the ambulance at Avin-le-Compte. During the fortnight there, he was also several times dyspneic. Strength left his legs and he could only get about on crutches. There was now a suppurating wound in the interscapular region where he had been struck by the shell fragment. Evacuated to Paris, he was operated upon on account of a tremendous abscess in the back, and the shell fragment and some bits of cloth were removed. The wound healed; but vague pains in the left thorax remained, especially when the man walked.
On examination, July 28, 1915, he would in the standing position hold his legs together with the feet resting on their external borders, especially on the left side. The toes were in plantar flexion, and the soles were arched upward more on the left side than on the right. In walking, the legs were always held in extension, the feet twisting outward. If an attempt was made to walk quickly, the man walked more and more upon the external borders of his feet, in such wise that the plantar surface and the heel turned up and became visible from above. He would get tired after five minutes’ walking even if he spread his legs out for a broader base of action. He could lift his legs only about 10 cm. from the bed, but could flex and slowly extend his lower leg on the thigh. He could not adduct or abduct the feet. Movements of extension and flexion of leg on thigh were jerky and abruptly terminated, as also movements of thigh on hip. The patient could not sit, and when leaning forward he could not straighten up against resistance. The reflexes were normal. There was no sensory disorder. The electric reactions were normal. Pupils normal. There was slight hypertension of the spinal fluid and a slight excess of albumin. There were no lymphocytes.
In accordance with Dejerine’s idea that these neuropaths always have antecedents looking in the same direction, it was found that he had always been an emotional person, easily affected, sympathetic with other people’s troubles, given to weeping. As Lieutenant, he had not had the courage to harangue his soldiers. He had often during his life felt his legs weaken during times of emotion and had sometimes been unable to walk, though nothing of the sort had happened during the campaign. He was sure he could get well, and wanted two months’ leave in order to get back to the front. There were no hereditary features in the case. A physician had told him that he had had meningitis. This possibly followed whooping cough. He had had orchitis after mumps at 16. He had not had children, nor had there been miscarriages since marriage at 21.