Prolonged bombardment; shell explosion (nearby?): Depression; suicidal attempt; hypertensive spinal fluid.
Case 207. (Leriche, September, 1915.)
A patient entered an evacuation hospital June 27, having come from an ambulance with a ticket reading, “Melancholic depression, with stupor—attempt at suicide (threw himself into a pond)—sprained ankle—to be evacuated, lying down, on a milk diet.” The patient was depressed, indifferent to surroundings, irresponsive, and did not even look at an interlocutor. There was no other somatic sign except a pulse of 62. He did not eat, and remained lying down, without movement. Lumbar puncture in a sitting posture yielded a clear liquid under pressure of 34. June 30, another lumbar puncture yielded clear fluid of a dichroic appearance when looked at from above. 25 c.c. were removed. July 1, there had been a good deal of improvement. The patient said he was better and began to take a little milk. July 2, there was still some improvement. Pulse 60. He said that his condition had lasted a month and that it followed a violent and prolonged bombardment for ten days in his sector. July 3, he was much better, began to look about, talk, and eat a little. July 4, lumbar puncture yielded a clear fluid with a pressure of 30, reduced to 22 after withdrawal of 20 c.c.
According to Leriche, explosion of large calibre shells or of a mine can produce cerebral or spinal symptoms, some of which are removed by lumbar puncture. The fluid is red shortly after the explosion and under hypertension for some days. Such hypertension may be found even in shell cases that have no other sign of cerebral condition. This particular melancholy patient had a relapse and another depression with fugue.