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

  • Silas Weir Mitchell
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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    caused disuse of the right arm, which suffered very much more than the left. But besides the pain, which in time passed away, there was developed early in the case an exquisite hyporsesthesia of the shoulder muscles on both sides, in- cluding the deltoids and trapezius. It extended over the dorsal region to the level of the lower wound, and spread out alcove as described. It was very accurately defined by the patient, on the lower line and on the right side, and the boundaries did not change. It was not confined to the skin, but affected the subcuticular tissues and muscles, so as to limit motion, owing to the pain it caused. The sense of touch is naturally dull upon the back, but it was easy to show that it was not lost anywhere, for loss of touch may oc- cur and sense of pain remain. In this instance a light press- ure on the skin gave pain, and was felt as touch. The patient was hurt in July, 1862. When he entered our wards, early in February, 1864, his symptoms were abating, so that after a month of treatment with bromide of potassium, he was able to mount guard. He was shortly afterward returned to duty, at his own request, although not entirely relieved. At this time, as we should previously have mentioned, his right arm was normal in range of movement, but was feeble in power, and measured rather less than the left; all of this may have been due to long disuse. This case was so interesting that we were at pains to satisfy ourselves of the verity of liis symptoms. The means for so doing were found in the absolute correctness with which, unaided by sight, he marked the limits of the hypersesthetic spaces, \vhen tested by drawing a pencil point across the boundary be- tween the healthy and the over-excitable regions. Had we entertained any further doubt it would have been set at rest by the numerous instances of con- tusions of the lower spine, which have come under our care, in many of which muscular hyperesthesia has been a prominent symptom. We shall fully show, in another place, that both cutaneous and 4*
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