Injuries of nerves and their consequences - Reflex Sympathetic ...

REMOTE SYMPTOMS. 171
Case 30.— Gunshot wound of the rirjht brachial plexus ;
caiisalgia;
tremor; arthritic lesions; nail-changes ; acid sweats ;
hyperesthesia ; little loss of motion from paralysis ; great gain
under treatment B. D. L,, aged forty-tliree, a farmer
from Maine. Enlisted July, 1862. lie was healthy to the
date of his wound, received July 2d, 1863, at Gettysburg.
While kneeling and aiming he was shot in the right side
of the neck. He felt pain in the wound, but none down
the arm. Tie spun around, feeling stunned, and fell on
his back, not unconscious. In five minutes he arose and
walked to the rear, where the wound was dressed with
cold water, no splint being employed either then or later.
At first, all motion was lost. In an hour he could move
his fingers and abduct the arm, but not flex it.
lie thinks
sensation was perfect, except as to the ulnar distribution.
AVithin an hour he had severe earache, and pain in the
shoulder, arm, and forearm. During the second week he
began to have burning pain in the hand. At this time,
which probably marked the onset of neuritis, the shoulder-joint
grew stiff, then the elbow, and lastly
all of the
fingers. This condition was excessively painful, and remained
unchanged. The tremor which is constant in the
upper arm muscles began the day of the wound, and had
not ceased on his admission to our wards.
— Site of wound. On admission, October, 1863, it was
noted that the ball had entered the right side of the neck,
in front, three inches above the clavicle, in the outer edge
of the trapezius. The missile passed downward and outward,
and struck the anterior edge of the supra-spinal
fossa of the scapula, five inches external to the spine of
the first dorsal vertebra. Both wounds slouo-hed, leavinof
scars one and a half inches in diameter. The patient
is
well and florid. The shoulder is motionless from stifihess.
The lower joints are alike stifi", swollen, red, and painful ;
the arm, semi-prone and flexed, is carried across the chest.