(119) Brachial plexus injury.—Wounded at Magersfontein. Entry, at the anterior border of the sterno-mastoid opposite the pomum Adami; exit, through the ninth rib below and 1/2 an inch external to the scapular angle. Emphysema and considerable blood extravasation developed in the posterior triangle of the neck, also loss of power in the musculo-spiral distribution, but no anæsthesia. At the end of the first fortnight there was evident wasting of the muscles, but some power was returning in the triceps. At the end of a month the man left for England, with fair power in the triceps, but well-marked wrist-drop. A year later the wrist-drop still persisted.
(120) Plexus injury.—Wound of entry, over pomum Adami; exit, below scapular spine, about centre. Complete median and musculo-spiral paralysis.
(121) Median, musculo-cutaneous, and musculo-spiral nerves.—The wound traversed the axilla from just beneath the anterior fold; three weeks later a firm mass in the axilla corresponded to the wound track. Hyperæsthesia developed in the area of median distribution, with deep pain in the muscles. There was rigidity of the biceps cubiti and slight wasting in the radial extensors. The patient improved slowly, and eventually was discharged and passed out of sight.
(122) Brachial nerves.—Wounded at Paardeberg. Range 500 yards. Entry, at the front of the arm, 2 inches below the junction of the anterior axillary fold; exit, a little lower, at the back of the arm, in the line of junction of the posterior axillary fold.
Considerable shock attended the primary injury; when reaction had taken place, complete motor and sensory paralysis was noted of the whole upper extremity, with the exception of some power of movement of the posterior interosseous group of muscles. Three weeks later the patient could extend the wrist, but sensation was imperfect in the arm, and completely absent in the forearm and hand. The track was now hard and palpable, but there was no hyperæsthesia in any area; when the track was manipulated slight formication in the hand was experienced. The biceps and triceps were equally paralysed. There was no wasting in any of the muscles.
(123) Brachial nerves.—Wounded at Modder River. Entry, through the anterior axillary fold at its junction with the arm; exit, on the posterior wall of the thorax, 1/2 an inch from the median line at a level with the angle of the scapula. Complete musculo-spiral paralysis; hæmothorax. Three weeks later, radial sensation returned; but the triceps was very weak, and wrist-drop was complete. There was some wasting of the muscles supplied by the median and ulnar nerves, and complete obliteration of the radial pulse. A year later the musculo-spiral paralysis still persisted.
(124) Musculo-spiral and median.—Wounded at Magersfontein. Entry, 3 inches below the anterior axillary fold, on the inner aspect of the arm; track passed obliquely downwards behind the humerus to a point on the outer aspect of the arm 1½ inch below the level of the entry. The humerus escaped injury. Musculo-spiral paralysis was complete; hyperæsthesia in the distribution of the median followed some days later. One month subsequently radial sensation had returned, and a feeling of numbness had taken the place of the median hyperæsthesia. The triceps and marginal muscles were much wasted, and only interosseous extension was possible in the fingers.
(125) Brachial nerves.—Wounded at Magersfontein. Entry and exit, in the upper third of the arm internal to the humerus. Complete median paralysis, anæsthesia in the ulnar area, and in the radial supply to the dorsum of the middle and ring fingers. Could flex, extend, and adduct and abduct the wrist; some power of flexion in index finger, in others none. The flexion of the wrist was dependent on the ulnar supply to the muscles of the forearm. No wasting of the interossei, skin normal except for a large trophic blister on the dorsum of the hand. Little improvement had taken place in this patient at the end of a year.
(126) Brachial nerves.—Wounded at Magersfontein. The wound traversed the lower part of the upper third of the arm, fracturing the humerus. Immediate complete loss of power in the arm was experienced, together with loss of all sensation. Three weeks later the humerus was united; the fracture was evidently the result of passing contact, and not of direct impact. The paralysis was still complete in the distribution of the median, ulnar, and musculo-spiral nerves. There was considerable wasting of the hand and forearm, and a good deal of thickening in the lower third of the arm.
Four months after the original injury, the nerves were explored by Mr. Eve, who kindly gives me the following information. All the nerves and vessels of the arm were united into one firm bundle by cicatricial tissue. When dissected clear, the median nerve was found to be thickened and enlarged for about 1½ inch of its length; the ulnar was not completely freed, but was found to be continuous and indurated; the musculo-spiral was also intact, but at its entrance into the humeral groove a mass of callus was felt. A sclerosed and thickened portion of the median nerve 3½ inches in length was resected, also 1 inch of sclerosed ulnar nerve, and both were sutured. The musculo-spiral nerve was left for future exploration. A small traumatic aneurism was found on the brachial artery, and the vessel was ligatured above it.