Wound near heart; delayed medical care; fear of having been shot through heart: Paraparesis (antebellum always “hit in the legs.”)
Case 289. (Dejerine, February, 1915.)
An infantryman, 20, was sent as a Colonel’s bicyclist about 1 p.m. September 30, 1914, with a message to one of the battalions. He was exposed on the way to shell and rifle fire, and was wounded by a bullet which entered 8 cm. below and internal to the left mammillary line and came out in the region of the left hypochondrium. He crawled to some village houses 20 or 25 meters away. Another cyclist came to transfer the order, but could not help him. A friend came to his aid but was struck by a bullet 10 meters off and remained on the ground for an hour while the young cyclist lay behind a tree on the roadside. At 3 o’clock it was possible to take him to a house around which shells were raining. Shortly afterward the house caught fire. The man was evacuated 6 kilometers to an ambulance in the night, and that night six of his wounded comrades died in the same room. The man had lost much blood and began to think that his heart had been hit. He choked, had violent palpitations, and intense thirst. By automobile next day he was taken to the railway station at Maison and was there for a day practically without food.
That evening, 36 hours after the wound, he was evacuated to Juivisez and stayed there one night in the temporary hospital. The hemorrhage had now practically ceased. When he arrived next morning at Vincennes he could hardly move, was unable to walk, had violent palpitation, precordial pain, and two nervous seizures, with outcries and weeping. Several days later he could not walk at all or raise himself in bed. He was operated on May 29; he afterward felt the same leg weakness and was still unable to walk. Early in December, when observed by Dejerine, he was able to stand on crutches with legs flexed, toes on the ground, and heels up. In walking he would scrape the ground with the dorsum of the foot. The wound was now healed. Suppuration had been intense and the scars were extensive. Lying down, the man could move, though slowly, his lower extremities in every way, nor was there any diminution in the strength of his flexors and extensors. The patient in making movements against resistance would let go quickly and jerkily. The plantar reflexes were flexor but weak. There was no other reflex disorder, no evidence of sensory disorder, nor any sign of neuritis or arthritis. Lumbar puncture gave a normal fluid without tension.
There were no hereditary features in the case. The man had been in childhood nervous and irascible, rolling on the ground, crying and weeping when crossed. He had had three attacks of appendicitis—one at 15 years and two at 19 years. After each attack he had felt weakness in the legs. He remembered, too, that after his nervous crises on being crossed, he had always felt this same weakness.
According to Dejerine, these paraplegic neuropaths, like functional gastropaths, cardiopaths, and victims of urinary disorder, have had earlier spells of the same kind, though milder than the attack which brings them to medical notice.
Wounds: Tic on attempts to walk; tremors. Recovery except for frontalis tic (ANTEBELLUM HABIT emphasized).
Case 290. (Westphal and Hübner, April, 1915.)
A substitute officer (mother nervous; always slightly excitable, easily fatiguable; had had a habit of wrinkling his forehead) sustained wounds September 8, 1914, in the foot and thigh. The wounds healed well, but in the hospital he slept badly and had battle dreams. When he essayed to walk, he had contractions of face muscles. There was a lively tic involving both face and neck muscles, with the head pulled to one side and backward. This grimacing was but slightly influencible by the will. There was a marked tremor of the arms. Gait was trippelnd. There were tremors of the whole body. There was also a slight hemi-hyperesthesia. The tendon reflexes were very lively; vasomotor disorders (feelings of cold and perspiration).