Civil War Washington

The following case illustrates what is known as concussion or "commotion" of the spine; it is not supposed that any large nerve could have been touched:

CASE 1076.—Thomas Carroll, aged 21 years, plumber, of New Jersey. Enlisted November, 1863, in Co. D, 3d New Jersey Cavalry. Healthy to date of wound. December 15, 1863: While seated on a fence rail, a pistol ball, accidentally fired, took effect on the back of his neck. It entered at the middle line, exactly over the interspace between the spinus of the sixth and seventh cervical vertebræ, and was cut out on the left side of the neck one inch below the angle of the jaw. No bone escaped at any time, and the surgeon who explored the wound at the time of the injury felt assured that there was no fracture. The patient thinks that he was looking to the left when hit, but is not sure. If he be correct as to his position, the ball could have come near to no part of importance except the spine, and, in any case, it would be difficult to assert that it could have wounded the cervical and still less the brachial plexus. He fell senseless, was removed to a hospital tent, and finally recovered his reason within two hours. As he became aware of his condition he found that although he could talk, see, and hear, he had neither motion nor feeling in any of his limbs. The trunk was equally powerless. He describes himself as at first unable to feel the bed upon which he lay, but as having good feeling in the head and face. About the second day he had severe pain and tenderness in the right shoulder and neck. Gradually, sensation first, and then voluntary power, returned to the whole right side. Within a month the left side also improved, with the exception of the left arm. Within two months the right side was well and the left leg nearly so. About May 1, 1864, he began to be able to stir the left thumb. Present state, May 14, 1864 (admitted May 12, 1864): General loss of flesh. Left arm exhibits marked atrophy. Measurements: Left biceps, 8½ inches; right biceps, 9¾ inches. Forearm, left, 8½ inches; right, 9¾ inches. Legs, no notable difference. The left shoulder muscles are fearfully atrophied, especially the deltoid. The arm has dropped, owing to want of support, so that a thumb may be laid in the furrow between the head of the humerus and the acromion process. This subluxation of the bone increases the apparent length of the left arm nearly half an inch. Casts of both shoulders, which exhibit well the deformities, were sent to the Army Medical Museum at Washington. There are no contracted muscles. The hand is swollen and congested, the cuticle thickened and hanging in yellow scales. Nails not curved. No acid sweat. Slight burning of the left palm a recent symptom. Tactile sensation and sense of pain absent in left ulnar distribution, and defective everywhere else in the arm below the shoulder. Normal in right arm. Sensation alike in the legs, and normal in both. The right arm is weak; the left arm powerless, except slight ability to abduct the thumb. The left leg is weaker than the right, and his gait is awkward, from his swinging his right leg outward and forward.