Shell explosion near by: Paraplegia, interpreted as due to windage. Two foci of HEMORRHAGE (SPINAL CANAL, BLADDER) clinically proved to exist in a case without external sign of injury.
An infantry sergeant was brought to the ambulance, one day in November, 1914, with a paralysis which had set in immediately upon the explosion of a large shell a short distance away. Both legs were paralyzed and there was anesthesia to the navel. He could not urinate. It was early in the war, and Ravaut thought he would find an injury to the vertebral column, but on undressing the soldier there was no wound. The skin was intact, and there was not even an ecchymosis. The patient was suffering not at all, but said that after the shell exploded he felt a forcible shock, was stunned for a moment, and when he wanted to rise, found that his legs were inert. His state did not change during the day and he did not urinate. Catheterization showed a urine full of blood. This indicated a lumbar puncture, and a bloody fluid emerged under great pressure. Thus two foci of hemorrhage were proven to exist in this patient despite the fact that there was no external lesion.
Re windage effects, see suggestions of Ravaut under Case 201. Ravaut also suggests that certain cases of emotional jaundice may be similarly explained on the basis of internal lesion due to windage. Sundry cases of gastro-intestinal disorder and of hemoptysis fall into the same class; possibly the cases of death in a fixed posture belong there, too. Ravaut thinks, despite the look of hysteria about the shell-shock cases of paraplegia, deafness, mutism, and the like, that the cases are actually ones in which there has been at the beginning a slight or severe hemorrhage, clearing up in a few days. He states that there is a pretty definite parallelism between the course of the clinical symptoms and the chemical characteristics of the spinal fluid.