Shell-shock and other neuropsychiatric problems : $b Presented in five hundred and eighty-nine case histories from the war literature, 1914-1918Southard, Elmer Ernest
History
Shell-shock and other neuropsychiatric problems : $b Presented in five hundred and eighty-nine case histories from the war literature, 1914-1918
Southard, Elmer Ernest
War neuroses; World War, 1914-1918 -- Medical care; World War, 1914-1918 -- Psychological aspects
A sergeant in a Chasseur Battalion was in a mine explosion and
entered hospital June 19, 1915, so agitated that he had to be tied to
the stretcher during transfer from the railway. There were remains
of epistaxis and blood in the right ear, not proved to be due to
otorrhagia; blue-black ecchymoses of both eyelids; and small ecchymoses
of the bulbar conjunctiva of the right eye. No other sign of trauma
or fracture. The explosion had probably taken place on June 17 or
18. Patient was but semiconscious and irresponsive; rolled upon the
mattress, beating the air with arms and legs, assuming fighting
postures and uttering cries. Urinary incontinence. No fever.
There was doubt as to the diagnosis, which lay between fracture and
concussion. The persistent agitation and oniric delirium pointed rather
to concussion. Without further sign, however, the patient died on the
night of June 20.
The autopsy was extremely careful and showed no sign of cranial
fracture of vault or base. The cerebrospinal fluid was strongly
bloodstained. The inner surface of the dura mater had a thin sheet
of hemorrhage, hardly 1 mm. thick, covering both hemispheres and the
cerebellum and spreading over the bulb. There was no distension of the
lateral ventricles. Serial sections of the brain showed no lesions of
the substance, except for slight hemorrhagic points.
According to Chavigny, so slight a meningeal hemorrhage is incapable
of producing a mechanical disturbance of the brain and the cause of
death could not be said to be meningeal hemorrhage. Massive multiple
gas embolism through sudden decompression is not a suitable explanation
of a case with death delayed, as in this instance, even if Arnoux’s
explanation is suitable for cases of immediate death.
Mine explosion: no skin, bone, or visceral consequences seen at AUTOPSY
(death in seven days) except slight LOCALIZED MENINGEAL HEMORRHAGE.
=Case 199.= (ROUSSY AND BOISSEAU, August, 1916.)
A soldier entered Val-de-Grâce February 27, 1915, in a state
of confusion following mine explosion the night before. He was
delirious, thought himself on leave, and had spells of excitement.
Lumbar puncture, February 29, showed a slightly darkened fluid, with
approximately normal amount of albumin, one or two lymphocytes and rare
red blood cells.
A brief period of slight improvement followed, but the restlessness
and delirium increased once more, became particularly severe March 3,
and the patient died on the night of the third, seven days after the
explosion.
The autopsy showed slightly congested lungs; no other lesion except a
sharply defined hemorrhage in the cervical spinal meninges and over the
meninges of the temporal and occipital lobes. Microscopic section of
the brain failed to show any hemorrhages within the brain substance.
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