Synesthesialgia: FOOT pain on rubbing dry HANDS, following bullet wound of leg.
Case 316. (Lortat-Jacob and Sézary, November, 1915.)
A foot chasseur was wounded, September 15, 1914, low in the right thigh, a bullet entering outside the biceps tendon and emerging on the inner aspect of the leg, 4 cm. below the knee joint. He at once began to feel pains in the right foot, which grew swollen and red. The leg began to flex upon the thigh and, after straightening under anesthesia, was placed in plaster. An arteriovenous aneurysm developed in the popliteal space; operation, October 22nd, followed November 1, by ligature. The pains in the foot grew better after this operation; but as soon as the wound was cicatrized they came back again as before.
For seven months the foot pains remained sharp and continuous, such that the man could not leave his bed. If a bright light struck his eyes, the pains grew much more marked, especially in the morning on awakening. The patient found that when his hands were dry he could not use them because of the violent pains which rubbing them would cause in the right foot. Accordingly he kept putting his hands to his mouth to moisten them. Finally he kept a wet rag by him which he could pass from one hand to the other.
The pain was what made walking difficult. Foot movements were only a bit less ample on the affected side than on the normal side. There was a general muscular atrophy of the lower extremity (30.5: 34 about calf, and 40: 49 about thigh). Right knee-jerk more lively than left. Right Achilles jerk absent. Negligible disorders of electrical excitability in the territory of the right sciatic nerve. The skin of the foot was a little thin and pale; the temperature was low; and the nails had transverse striations. The pains grew gradually a little less marked, but if the room temperature was increased or lowered or if the foot became cold, the pains became extreme. Pressure on the popliteal space produced pain on the external border of the foot; likewise pressure on the calf. Lasègue’s sign could not be tested for on account of the contracture of the flexors of leg on thigh. Due to the direct action of the bullet, there was an objective hyperesthesia of the dorsum and sole of the foot. The toes were anesthetic. A cold foot bath increased the pains, and a warm foot bath diminished them (contrary to experience in analgesias).
This was a case of synesthesialgia in the right foot, brought about by rubbing dry hands, exactly as if there were a direct contact with the foot. Milder painful reactions were brought about by bright lights and loud noises; but on the whole, these other effects were insignificant. It must be remembered that the man was wounded and plainly had also organic nervous disorder. He sometimes complained of radiations of the pain up to the left hypochondrium, and sometimes he showed the classical sensation of “esophageal globus” (lump in the throat). In short, there was in him a special excitability of the nervous system which may partly explain the synesthesialgia.
Shell-shock; burial: Clonic spasms; later, stupor with amnesia.