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

TREATMENT. 315
and downward, and made exit two inches below the
inferior angle of the left scapula, three and a quarter
inches from the spine. The ball was fired by a skirmisher
not twenty yards distant, and was received while
the patient was in the act of bending forward to aim.
He fell, giddy, but conscious ;
tried to move, but failed,
and fainted from loss of blood. After several hours he
revived, and discovered that the left arm and hand were
sensitive throughout. On the radial side of the forearm
there was slight numbness, a condition compatible with
perfect tactile sensibility. Motion appears to have been
lost or greatly lessened during some hours, and within a
day to have become restored entirely. ISTo doubt exists
as to this point.
ISTo dressing was used until the third day, when cold
water w^as applied. At this date the arm motions were
complete below the shoulder, and there had been no pain.
Soon after the cold dressing, to which he attributed the
sequent symptoms, he was seized wdth neuralgic pain,
which was principally in the median nerve distribution,
but also on the outside of the arm and shoulder, with a
spot of intense pain at the deltoid insertion. The pain
was darting and pricking in its nature. Coincidently
with the pain, the joints of the fingers swelled and became
sore, and this was especially the case with the
thumb and the fore and second fino-ers. At the same
time the shoulder muscles grew weak, flexion of the
fingers feeble, and the flexion of the forearm became
aft'ected. All of these defects increased for several
months, and the flexor group in the forearm wasted so
much as to attract attention. The biceps, brachialis anticus
and coraco-brachialis were in like manner atrophied.
The pectoralis major was also thus altered at a still
earlier period. The patient spat blood freely up
eighth day, when the hemorrhage ceased, and he has had
since then no pulmonary difficulties of any kind.
to the