water-carriers of the town of Rennes are liable. An account of this singular malady is given by M. Bachon.*

The water-carriers use a huge iron vessel, holding about eighteen quarts of water, and furnished with a single handle on the side. The belly of this great vase rests on the antero-lateral part of the thorax. The arm thrust through the handle, which is turned outward, embraces the circumference of the jar, which it presses against the side. At the same time the humerus is thrown outward and upward, so as to give the handle a solid support. This enormous load, which is at least seventy-six pounds, exerts by the agency of the handle a strong pressure on the external and posterior region of the arm, crossing obliquely the direction of the radial nerve. Paralysis of the extensors of the wrist and hand is a common consequence, and in some instances this is complicated by neuritis, of which the reporter gives a clear and interesting

account.

Crutch palsy.-A common cause of paralysis from pressure in army practice, but one very rare in civil life, was known to our hospital staff as "crutch palsy." Early in the war a great number of instances of this malady were sent to our wards, and some occurred while patients were under our own care. Such were usually emaciated men, who, being of large stature, and therefore of great weight, bore heavily upon the cross-piece of the crutch, which was commonly of wood, and not cushioned. I do not recollect seeing this malady in any person whose axilla was well defended by adipose tissue, and by the firmness and tone of the muscular folds which bound it before and behind. Neither was it frequent after the wounded began to be supplied with a proper form of crutch. The trouble

* Rec. de Mém. de Méd., de Chir. et de Pharm. militaires, t. ii. (3 série) quatrième Fascicule, No. 52, Avril, 1864.

was met with, of course, in men who had to bear hard on the crutch because of a wounded or lost leg. The paralysis begins with a tingling and numbness in the little finger of one hand, ordinarily the right, with sometimes a loss of feeling in the ulnar distribution. Then the hand grows feeble, or this symptom comes on, though rarely, without previous or accompanying sensory phenomena; but at last the patient can no longer grasp his crutch, so that inevitably the disease brings its own remedy of entire rest, although it does sometimes continue to increase for a time after the crutch has been abandoned. I have seen no case which failed to get well, though in certain instances of pressure from other causes the palsy has been found to be permanent.

The following history sufficiently illustrates this form of pressure:

Q. C. Meanning, aged forty, Company B, 1st Mass. Cavalry. Enlisted Sept. 1861. He was previously well. In January, 1863, he fell, breaking both bones of the right leg. Union took place, with deformity and unusual difficulty in locomotion. From April 25th to June 20th he walked on two common wooden crutches, and then, until July 11th, on one, which he used on the right side, leaning heavily upon it. On the last - named day he walked a great deal more than usual, and immediately after found that the third and fourth fingers were benumbed. The following night he lost partially the use of the arm. The axilla felt sore, but there were no evidences of any central lesion, or of syphilitic or rheumatic antecedents.

Since then his biceps regained power, but no other muscle had improved up to July 21, 1863. At that time his shoulder muscles acted well, except the deltoid, which was feeble. The other muscles of the arm were healthy. The biceps was feeble; pronation and supination were

good; flexion and extension of the wrist were nearly absent; the finger motions were all excessively weak. Sensation was absent in the ulnar side of the palm, wrist, and forearm, and nearly absent in the forefinger. In the forearm muscles, the electric contractility was lessened, and was barely present in the abductor min. dig. The axillary nerves were not tender on pressure.

Treatment. The patient was directed to use a cane in the left hand, to have a starch bandage as a support for the broken leg, douche and faradisation daily to the forearm. The relief was very rapid and complete; so much so that within two months he recovered the full use of the weakened muscles. Sensation returned more slowly, but finally was aided by faradisation of the dried skin. He was put on guard duty after four months' treatment, but had then, I believe, some slight numbness in the fourth finger and ulnar palm.

CHAPTER VI.

SYMPTOMATOLOGY OF NERVE LESIONS.

THE character of the symptoms varies but slightly in the different forms of nerve injury. If we had presented to us a hand which was suffering from wound of the median nerve, there would be nothing in the symptoms to show how they were caused, and the hurt might have been due to gunshot wound, to incision, to a puncture, or to a simple contusion of the nerve. Moreover, the symptoms in nerve wounds rise into the highest practical importance as regards treatment, and are so much alike in all regions of the body, that it seems better to deal with them collectively than to describe, in tedious detail, the nerve wounds of each limb, and so to be forced into endless repetition of the same particulars in numerous

cases.

I have chosen, therefore, to treat of the symptoms in successive chapters, and to reserve for separate study the wounds of such nerves as, by position or function, demand peculiar consideration.

Local symptoms.-The immediate symptoms of nerve injury are local and general. I have questioned hundreds of men who have been shot through nerve trunks, and have found a curious diversity as to their first sensations. Usually the man thinks he is struck with a stick or stone, and angrily accuses a comrade of the trick. Others suffer instant and intense pain, which is felt at the wound

and down the nerve tracks. A clever sergeant, a Canadian by birth, described his first pain as like that which is felt when a cricket-bat carelessly held is struck by a swift ball. This feeling of numbness, with tingling pain, is common in cases of slight nerve wounds or contusions. Even when the primary pain is severe, it is lost in a few moments. Indeed, cases of pain which arise at the moment of the hurt, and continue steadily, are very rare. I recall but one instance, that of a man who said he had burning pain in the hand from the instant he was hit.

In the book on Gunshot Wounds and Injuries of Nerves, by Drs. Morehouse, Keen, and myself, forty-three cases of nerve wounds are analyzed in regard to the immediate symptoms. To these I now add forty-eight. Of the ninety-one so brought together, rather more than onethird had no pain, and many did not know they were shot until weakness or the sight of their own blood betrayed the presence of a wound.

We may suspect that the difference as to pain in these cases depends upon the rate of motion of the ball, which, if slow, would be more likely to cause pain. Indeed, we all know from personal experience how little pain is given by a sharp cut made quickly, and it has even been proposed by Dr. Richardson to utilize this fact in order to open abscesses without pain. I presume that a man in a high state of excitement would be less apt to know of his being wounded, and this is certainly the case; but there are also men who have been shot through the brachial plexus while quiet spectators, and have first been informed of it by the flow of blood.

Other and rare cases have remote pain, and none at the point hurt. I have seen an instance where the ball, having traversed the inner and upper region of the thigh, partly divided the sciatic nerve. The pain was altogether