Mine explosion. Ecchymoses; no bone or visceral consequences seen at AUTOPSY (third day after explosion) except SUBDURAL HEMORRHAGE and PUNCTATE HEMORRHAGES OF BRAIN.
Case 198. (Chavigny, January, 1916.)
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.