Shell-shock: low blood pressure: Pituitrin.
Case 485. (Green, September, 1917.)
A lance corporal of the Expeditionary Force, 26, went to France feeling very fit, February, 1916. He was blown up by a shell July 1, and faintly remembered crawling out of some water. He came to in a dugout, dumb and partially deaf, and was blind for a few minutes. August 17, he was admitted to Mott’s wards at Maudsley, mute but with hearing normal. The hands were dusky, sweating, cold, and slightly tremulous. He was given to battle dreams and used to wake in a sweat and terror after a pantomime of bomb-throwing. He had headache and was depressed. He complained of feeling cold and the surface temperature was subnormal. The blood pressure was also subnormal (according to Green, nightmares are most marked in cases with low blood pressure; these are, in fact, severer cases of Shell-shock than cases with high blood pressure; only 10 of 27 cases with blood pressure above 120 showed nightmares).
September 25, he was able to speak in a whisper. The dreams had become less terrifying. The other symptoms had been slowly improving.
November 25-28, all of the symptoms returned upon hearing the death of his brother in action.
The man was now put on extract of pituitrin gr. 2, t.d.s. (better results are claimed by Green from pituitrin extract than from pituitary fluid injections, as these sometimes cause dizziness, of which no case treated with extract complained). As in other cases, the extract was immediately followed by an increase in blood pressure, a general improvement and a diminution of headache and depression. The bomb-throwing pantomimes still persisted, but the patient was less weak on waking. The treatment was continued for seven days, whereupon the surface temperature began to rise and the patient himself felt that he was much warmer. The pituitrin was discontinued after a month’s treatment, yet the improvement persisted. The man was boarded out of the army and in March, 1917, wrote that he was still feeling better.
SHELL-SHOCK, PITUITRIN, AND BLOOD PRESSURE (EDITH GREEN)
Blood pressure, surface temperature, and pulse in a case of functional mutism. (a) On admission, troubled by nightmare. (b) Able to speak in a whisper. (c) Much depressed after bad news. (d) Put on pituitrin. (e) Marked general improvement. (f) Taken off pituitrin.
A-1 Showing the effect of pituitrin on the blood pressure and surface temperature. Each dot is one week’s interval. + is the pressure when the first dose was given. 𐌈 is the point at which the pituitrin was discontinued.