Gunshot wounds and other injuries of nerves / by S. Weir Mitchell, George R. Morehouse, and William W. Keen.

  • Mitchell, S. Weir (Silas Weir), 1829-1914.
Date:
1864
Catalogue details

Licence: Public Domain Mark

Credit: Gunshot wounds and other injuries of nerves / by S. Weir Mitchell, George R. Morehouse, and William W. Keen. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    mar face of all the fingers; but only in the dorsum of the hand, and not on the dorsal aspect of the fingers. Motion.—Good above elbow. Supination and pronation normal. The wrist flexion is incomplete from want of power. Extension limited by flexor contraction. Thumb.—Flexion partly lost from want of power, and extension limited by contraction of short flexor. He has no abduction nor adduction of the fingers, and cannot flex the first phalanges, or extend the last two. Hence there is paralysis of the interosseal group. It is not necessary to speak in detail as to the electric properties, which were wholly absent in the interosseal mus- cles, and defective in some others. Treatment.—Electricity, douches; splint to correct flex- ions. Under this treatment, with energetic use of passive motion, the flexions were corrected, and every motion re- gained, except that of the interosseal muscles. To have a prothetic apparatus, and be discharged. April 9, 1864.—The hand is now healthy in color, the neuralgia nearly entirely well. Remarks.—This is a fair illustration of what care and perseverance may do for a severe case of nerve lesion. The claw hand here spoken of is well figured by Duchenne. We hold, with this author, that the interosseal group and lumbrici abduct and adduct the fingers, and are the extensors of the second and third digital phalanges; that the exten- sor com. digitorum acts only primarily on the first phalanx. The flexion of the first phalanges is done by the interossei; that of the second and third, by the two flexors sublimis and profundus alone. Thus, in Gervaise's case, the interosseal group only is paralyzed, and as a consequence the flexion of the first phalanges is lost as an independent act. When the flexors of the other phalanges contract, they first flex the second and third phalanges, and finally roll