Complete motor and sensory paralysis, with absence of reflexes below umbilicus. Retention of urine, incontinence of fæces. Large sacral bed-sore developed rapidly. Right hæmothorax.
The patient emaciated rapidly, and for the last fourteen days the temperature ranged to 104°, the bed-sore steadily increasing in size. Death occurred on the forty-second day.
At the post-mortem a Mauser bullet was found embedded in the centrum of the twelfth dorsal vertebra. The bullet was slightly curved; its anterior extremity had passed across the spinal canal, and wounding the dura posteriorly rested against the left lamina. The plating of the mantle of the bullet was stripped from half the area of the tip. The dura was not adherent, and the cord was softened for half an inch above the point of section; above this it was normal, the vessels coursing normally to the softened spot. Below the point of section the cord was blanched, but offered no other macroscopic evidence of disease. No evidence of either intra- or extra-dural hæmorrhage was detectible.
Fig. 80.
Complete division of Spinal Cord. The bullet is retained, and from its position can be seen to have struck the right half of the cord only. The nickel plating of half of the tip of the bullet is stripped off. Case No. 104
The right pleura contained a large quantity of dark cocoa-like fluid. Extensive adhesions were present in both pleural cavities. The spleen was much enlarged. At the base of the bladder a large submucous hæmorrhage had occurred, the blood-clot had assumed a dark orange colour, and on first opening the viscus the appearance was that of a mass of fæces. The mucous lining elsewhere was slaty grey, with small hæmorrhages. The kidneys were large, but no abscesses or pyelitis were present.
(105) Cervico-dorsal region; total transverse lesion.—Wound of entry (Mauser), opposite right sixth cervical transverse process; exit, on left side of third dorsal spinous process. Slight grasping power was present in the hands, and the patient could hold his arms across his chest. Complete motor and sensory paralysis, with absence of all reflexes below. The pupils were moderately contracted. Retention of urine. On the second day blebs appeared on each buttock, and the patient complained of very severe pain in the neck: the temperature rose to 103°, and on the third day he died suddenly. No post-mortem examination was made.
I observed two similar cases in the Field Hospital at Orange River, the patients dying on the third day; pain and high temperature were prominent symptoms in both. In one patient early delirium was present.