Shell explosion; unconsciousness: Amnesia; paralyses. Reëducation.
Case 589. (Batten, January, 1916.)
A corporal in the Belgian army was mobilized when the war broke out, and was in action continuously in the retreat from Liège, in the siege of Antwerp, and finally on the Yser until October 27, 1914, when the explosion of large shells rendered him unconscious. He recovered consciousness only in hospital at Calais. Though he was able to see and hear well, he was dazed and remembered nothing of what had happened. In fact, he did not understand what was said to him.
In a week’s time, his memory and intelligence returned, save for periodic attacks in which he was dazed. From the very beginning he had been quite unable to move his legs, and at first the arms were weak. He had a series of attacks of violent struggling in November and December, 1914, which the corporal himself called fainting attacks, claiming that he did not move his legs in the attacks but only his arms. In fact, he claimed that he could move neither head, body, nor legs, but only the arms. He said, “Sometimes I try hard and set my teeth, but I do not know how to move my head and my legs; I try but they do not move.” Sphincter control was maintained. Although he could see, when he attempted to read, everything went black.
He was finally admitted to the National Hospital for the Paralyzed and Epileptic on July 8, 1915, on the service of Major Walshe. He was thin and wasted. He was firmly convinced, according to the notes of Major Walshe, that he was seriously paralyzed. He said he could not lift his head; when his body was lifted, his head fell back, or rather perhaps was definitely thrown back, lolling about alarmingly. However as he lay in bed he frequently lifted his head unconsciously and placed his hands under it. When asked to lift his head, the sternomastoids were strongly contracted, but at the same time the neck extensors also, so that the head was stiffly and strongly held in an extended position. Despite the patient’s statement that he could not move the trunk muscles, he could turn over readily in bed, and when trying to move the head the trunk was fixed in a strong opisthotonos, and the abdominal walls were rigid. When requested to move his legs, he made no movement whatever, though during head movements the legs were strongly fixed in extension. On passive movements, there was no active muscular resistance. There was an indefinite blunting of all kinds of sensations. Reflexes were normal.
Major Walshe worked hard with the patient, inducing him first to lift his head from the pillow, and finally to move the legs. In three weeks’ time, the corporal could just sit up, and at the end of another month, he was able to stand in the walking machine. At the end of a third month, he was walking upon crutches, and at the end of another, he could walk upon two sticks with his feet wide apart, moving as if glued to the floor. To quote Batten, “The corporal will eventually get well but not, I think, before the end of the war.”