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

TREATMENT. 255
now absent in a single muscle. In the left arm and forearm
it is
very sliglitl}^ if at all diminished. In the left hand
all the muscles respond, the general loss being about onehalf;
but in the first and fourth dorsal interosseal, about
three-quarters or more.*
Temperature (the thermometer being placed in the
metacarpo-phalangeal fold, where both hands could close
on it about equally well), after being tested for half an
hour in each hand, was, right, 95 J° ; left,
96° Fahr.
I have alluded to the fact that the temperature in
parts partially paralyzed by wounds was in some cases
higher than upon the healthy side. This was especially
noticeable in the instances of causalgia described
by my colleagues and myself. As the facts here referred
to had excited some little doubt, I lately examined in the
case of Schiveleyf the thermal condition three years after
he left the hospital. To my surprise I found that, despite
the great changes made by time, the temperature of the
injured hand was still slightly higher than that of the
other member. Scbiveley had severe burning pain. Gervaise,
the patient last described, suffered only from neuralgia
of the ordinary type.
In this man, the liexors of the hand were wasted as well
as the muscles of the thumb and the interosseal group.
The short fiexor of the thumb, and the flexor mass in the
forearm, were moderately contracted. The former defect
allowed the thumb extensors " to act on it, so as to brina^
its
metacarpus level with those of the palm, and to turn
the nail upward so that it lay in the same plane with the
fingers." There was, therefore, palsy of the interossei,
and in consequence a condition which made the hand
* By means of the battery he can make a good fist, being able to bring
the thumb into perfect apposition with the fingers.
f Gunshot Wounds and other Injuries of Nerves. — Case.