Shell explosion: Paraplegia; sensory symptoms.
Case 238. (Hurst, January, 1915.)
A lieutenant, 23, came to the ambulance September 15, 1914, having the morning before been to the firing-line with his company and thrown to the ground on his back by the explosion of a shell which he had seen falling behind him. He had not lost consciousness, but was unable to rise. After a night in the relief post, he was brought by automobile 12 kilometers to the ambulance. He complained of pain in the back, though no wound or ecchymosis could be found there, nor any painfulness of spinous processes or irregularity of bone. He had not emptied the bladder from the time of the shock. Preparations were made to catheterize on the morning of the 16th, when the patient after effort became able to micturate. There was crural paraplegia such that he could not sit or walk even when supported. Lying down, he could move his legs slightly sidewise. Anesthesia to pin-prick and temperature was complete to the groin; but tactile anesthesia was found only in the sacral root territory, namely in the feet, the outer aspect of the legs, the posterior surface of the thighs, and the scrotum. There was loss of sense of position for the toes. The plantar reflexes were abolished; but there were no other reflex disorders; nor was there any evidence of other disorder.
September 20, the man was evacuated by sanitary train in the same status as at entry. January 27, 1915, the patient could walk on crutches, supporting himself in part on the left leg. The lumbar pain had largely disappeared.
Hurst regarded this case as one of organic origin due to commotio spinalis.