At the end of the fifth week slight power was regained in the flexors and abductors of the right thigh, and the same muscles of the left limb could be made to contract feebly. Meanwhile the patient suffered with severe fever, accompanied by frequent rigors and profuse sweats; the bed-sore continued to extend, and the urine was foul and contained pus.
The patient continued in a similar condition, progressive emaciation and exhaustion taking place, and at the end of six weeks he died.
At the post-mortem the bullet was found to have tracked beneath the right scapula, entering the chest by the fifth intercostal space and lacerating the right lung; thence it entered the eighth dorsal centrum and tunnelled both this and the ninth diagonally, to escape beneath the ninth rib. On opening the spinal canal the tunnel was found to be separated only by the compact tissue of the centrum from the cavity, while a thin extra-dural hæmorrhage separated the dura from the bones anteriorly. The spinal cord exhibited no sign of pressure and was firm and continuous, but up to the lower limit of the dorsal region there was septic myelitis and meningitis, the result of pus having tracked up the canal from the sacral bedsore. Suppurative cystitis and pyelitis were present. The patient was the subject of an old urethral stricture which had given rise to trouble during treatment.
(103) Dorsal region; total transverse lesion; slight intra-dural hæmorrhage.—Wound of entry (Mauser), below spine of scapula, close to right axilla; exit, 2½ inches to left of tenth dorsal spinous process.
Complete motor and sensory paralysis below ensiform cartilage, with well-marked hyperæsthetic zone around trunk. All reflexes absent. Retention of urine. Incontinence of fæces. Bed-sores in sacral region developed during the first two days, and seventeen days later well-developed serpiginous trophic sores developed on the outer side of each leg and continued to increase slowly until death. The paralysis remained of the absolutely flaccid variety. Great emaciation occurred, accompanied by hectic fever, the temperature ranging from normal to 102.5°. During the third week double pleurisy developed.
At the post-mortem no bone injury could be detected. The cord and dura-mater were adherent over an area corresponding to the fifth to the eighth dorsal vertebræ, and opposite the seventh the cord was soft and of the consistence of butter. A small intra-dural hæmorrhage was still evident below the main lesion, not extensive enough to give rise to serious compression. General adhesions in each pleura. Cystitis.
Fig. 79.
Appearance of Spinal Cord enclosed in membranes in case 103 after removal from the canal. When the membranes were opened a white custard-like substance took the place of the cord. Slight evidence of extra-dural hæmorrhage existed
(104) Dorsal region; section of cord; retained bullet.—Wound of entry (Mauser), in seventh right intercostal space, 4½ inches from the dorsal spinous processes, oval in outline; bullet retained.