Civil War Washington

CASE 1089.—J. H. Corliss, late private, Co. B, 14th N. Y. S. M., aged 27 years, shingle dresser, enlisted April, 1861, in good health. At the second Bull Run battle, August 29, 1862, he was shot in the left arm three inches directly above the internal condyle. The ball emerged one and a quarter inches higher, through the belly of the biceps, without touching the artery, but with injury to the median and ulnar nerves. He was ramming a cartridge when hit, and "thought he was struck on the crazy-bone by some of the boys for a joke." The fingers of both hands flexed and grasped the ramrod and gun tightly. Bringing the right hand, still clutching the ramrod, to the left elbow, he felt the blood and knew he was wounded. He then shook the ramrod from his grasp with a strong effort, and unloosened with the freed hand the tight grip of the left hand on the gun. After walking some twenty paces he fell from loss of blood, but, still conscious, attempted to walk several times and as often failed. He was finally helped to the rear, taken prisoner, lay three days on the field without food, but with enough water to drink, and had his wounds dressed for the first time on the fourth day, at Fairfax Court House. On the second day the pain began. It was burning and darting. He states that at this time sensation was lost or lessened in the limb, and that paralysis of motion came on in the hand and forearm. His statement is unsatisfactory and indistinct. Admitted to the Douglas Hospital, Washington, D. C., September 7, 1862. The pain was so severe that a touch anywhere, or shaking the bed, or a heavy step, caused it to increase. The suffering was in the median and ulnar distribution, especially at the palmar face of the knuckles and the ball of the thumb. Motion has varied little since the wound, and as to sensation he is not clear. Peter Pineo, Surgeon, U. S. V., now Medical Inspector U. S. A., exsected​ two or three inches of the median nerve at the wound. (See Army Medical Museum Specimen No. 959.) The man states, very positively, that the pain in the median distribution did not cease nor immediately lessen, but that he became more sensitive, so that even the rattling of a paper caused extreme suffering. He "thinks he was not himself" for a day or two after the operation. It seems quite certain that the pain afterward gradually grew better, both in the ulnar and median tracts. Meanwhile the hand lay over his chest, and the fingers, flexing, became stiff in this position. About a week after he was shot the right arm grew weak, and finally so feeble that he could not feed himself. He can now, April, 1864, use it pretty well, but it is manifestly less strong than the other. The left leg also was weakened, but when this began he cannot tell. He gives the usual account of the pain, and of the use of water on the hands and in his boots, as a means of easing it. Present condition, April, 1864: Wound healed; cicatrix of the operation two and a half inches long over median nerve. The forearm muscles do not seem to be greatly wasted. The interosseal​ muscles and hypothenar group are much atrophied, and the hand is thin and bony. The thenar muscles are partially wasted. The skin of the palm is eczematous, thin, red, and shining. The second and third phalanges of the fingers are flexed and stiff; the first is extended. Nails extraordinarily curved, laterally and longitudinally, except that of the thumb. Pain is stated to exist still in the median distribution, but much less than in the ulnar tract, where it is excessively great. He keeps his hand wrapped in rags wetted with cold water and covered with oiled silk, and even tucks the rag carefully under the flexed finger-tips. Moisture is more essential than cold. Friction outside of the clothes, at any point of the entire surface, "shoots" into the hand, increasing the burning in the median sometimes, and more commonly in the ulnar distribution. Deep pressure on the muscles has a like effect, and he will allow no one to touch his skin with a dry hand, and even then is careful to exact a tender manipulation. He keeps a bottle of water about him and carries a wet sponge in the right hand. This hand he wets always before he handles anything; used dry, it hurts the other limb. At one time, when the suffering was severe, he poured water into his boots, he says, to lessen the pain which dry touch or friction causes in the injured hand. So cautious was he about exposing the sore hand that it was impossible thoroughly to examine it; but it was clear to us that there was sensibility to touch in the ultimate median distribution, although he describes sensation as somewhat lessened in this region, and states that he has numbness on the inner side of the palm and in the third and fourth fingers (ulnar tract). When the balls of the first and second fingers were touched he said he felt it; but, on touching those of the third and fourth fingers, he refused to permit us to experiment further, and insisted on wrapping up and wetting the hand. He thus describes the pain at its height: "It is as if a rough bar of iron were thrust to and fro through the knuckles, a red-hot iron placed at the junction of the palm and thenar eminence, with a heavy weight on it, and the skin was being rasped off his finger ends." (Mitchell, Morehouse, and Keen, loc. cit., p. 109.) The following information was received from Douglas Hospital, under charge of Surgeon Peter Pineo, U. S. Vols.: "The ball passed through the inner and anterior part of the arm at the junction of the middle and upper thirds, apparently involving the median nerve. He entered this hospital September 1, 1862, suffering excruciating neuralgia of the palmar portion of the hand and fingers. The wound healed kindly, but the pain in the hand continued in its intensity, yielding to no treatment, though nervous remedies, both local and constitutional, were resorted to. The extreme suffering produced an exalted sensibility of the entire nervous system which manifested itself in an extraordinary excitability of the patient, he complaining bitterly at the least jar or noise in the ward. This sad condition increased in severity until December 9, 1862, when the operation of resection of the median nerve was performed by Dr. Peter Pineo, in charge of the hospital. The patient being etherized, about two inches of the nerve was removed and the wound closed by adhesive strips. After the effect of the ether passed off the patient still complained of much pain in the hand, but seemed to think it was not so intense as before the operation. The patient's appetite continued good through all this suffering, and he was allowed a liberal diet. For several days after the operation the patient was allowed sulphate of morphia; but it was soon entirely withdrawn. The wound healed by first intention, but there seemed to be no positive improvement in regard to the neuralgia until December 14th, five days after the operation, when he was moved to a separate room; after which the hyperæsthesia seemed perceptibly to subside. February 14, 1863, the patient was discharged from the service at his own earnest solicitation. At this time he was able to walk about the room at night, but still suffered very much from the slightest excitement." Examiner J. T. Burdick, of Brooklyn, reported, October 23, 1866: "A ball perforated the arm three and a half inches above the condyles, injuring the median and ulnar nerve trunks. He alleges that two inches of the median nerve were excised by the surgeon; the existence of a longitudinal eschar three inches in length tends to confirm the statement. The fingers are rigidly flexed into the palm. The arm and hand are atrophied. In my opinion the disability is equal to the loss of the arm. The Brooklyn Examining Board, Drs. McCollom and Leighton, reported, September 18, 1873: "Contraction of thumb and fingers into palm of hand. Extreme sensitiveness of the fingers. Arm and hand useless."