Shell explosion with subject lying down applied to machine-gun; no contusion: HEMATOMYELIA. Partial recovery.
Case 209. (Babinski, June, 1915.)
A veterinary student, six months captive in Germany, wrote out for Babinski the following:
“September 1, 1914, I was about to operate a machine gun when a shrapnel shell exploded very near me,—probably about two or three metres overhead. I base this estimate on comparisons made with shells I saw exploded beside me before this one.
“Just after the explosion, which deafened me and at the same time took my breath away a little, from the powder, I felt a rather severe pain in the kidney region,—a pain which then persisted without interruption. I moved my left arm, to find the effect produced by a bullet which I heard whistle by my ear and which struck the upper part of the left shoulder without entering. At the same time, I tried to turn to see what had become of my legs, and had a feeling that they had vanished. Almost immediately I felt little prickings, not very painful, in the lumbar region and in the upper part of the thighs. Just then, seeing my comrades going away I tried to imitate them, but could not. All these feelings passed very rapidly.
“A comrade then came near to tell me to go back. I told him that I could not move and that I must have been wounded in the lumbar region. He looked at my kit and my coat and said there was no trace of shot or tear. Not wanting to leave me, he lifted me by the armpits and knees. I could not help him get me up, and my legs hung flexed and inert. After a few steps he had to put me down, and tried to stand me up. I immediately crumpled. I had no sensation of my feet touching the ground. I sent my comrade back, asking him to tell my brother, who was in my squad. I did not lose consciousness or any feeling of my situation, or of the danger being run by my comrade.”
The man remained four days on the battle field without food. He was on the edge of a stream. He did not defecate, nor for two days did he urinate. Eventually the bladder and rectal functions were re-established, though they remained irregular. Catheterization was never resorted to. The lumbar pains were diffuse, fixing themselves a few days after the accident in the region below the umbilicus. There were pains at the waist predominating on the left side. The paralysis of the lower extremities grew rapidly better. Movements in the right leg reappeared, and 27 days after the accident the man was able to stand and walk around his bed. Still further movement followed (left leg weaker).
At the time of the report, May 28, 1915, the patient could walk without a cane, but he could get about only slowly. The left toes would rub against the ground, and he could not support himself for any length of time on his legs. The knee-jerks were exaggerated, especially the left. The Achilles jerks were increased. There was a Babinski reflex on the left side and an abduction of the fifth toe on plantar stimulation. The same reflexes were found on the right side, but less marked. Abdominal reflexes absent, except the right superior reflex, which was distinctly present. Cremasteric reflexes absent. Anal reflexes preserved. The defense reflexes were exaggerated, but more markedly on the left side. The zone from which the defense reflexes could be elicited on the left side included the whole lower extremity and rose as far as 2 or 3 cm. above the nipple. Stimulation of the lateral parts of the left lower extremity would even produce defense reflex movements on both sides of the body. On the right side, however, the defense reflex movements could only be tried out by scratching the anterior surface of the ankle, which was then followed by a flexion of the foot.
Sensibility to touch and deep sensibility were preserved; but sensibility to temperature and pain, normal on the left,—i.e., paralyzed—side, was weak in the right leg. There was a marked sudation on the left side, limited by the white line, the inguinal fold, the iliac spines, and a horizontal line passing through the umbilicus.
Here, then, paralysis followed a shell explosion while the subject was lying down. No contusion therefore was possible. According to Babinski, we are dealing probably with a hematomyelia, the result of shell explosion.