CASB 1079. — Private John C. Dyre, Co. E, 71st Pennsylvania, aged 19 years, was wounded at Gettysburg, July 3, 1863. While aiming, a ball entered just behind the left ear at the level of the meatus. It broke the mastoid process slightly, and was said to have gone forward and downward. It has not been found. He fell unconscious, and reviving within about two hours at a hospital, where he had been carried, he found that he could not use the jaw, owing to pain in the ear. There was also pain in the left cheek and brow, left neck, shoulder, arm, and hand, together with the left chest. The left arm was weak for several days. He may have fallen upon it. The pain was a neuralgic ache, not the pain of a bruise. Water dressings were used after a vain search for the ball. Within two days he had pain in the lower teeth and jaw on the left side. After five weeks all the pains grew better rapidly, and at the same time the motions of the jaw returned. The ear was deaf from the first; but he does not know whether blood flowed from it or not, or when pus first came from it. Present state, February 14, 1864, eight months after reception of wound: The features are slightly drawn to the right in repose, and excessively so during laughter and speech. Specimen 1567, in the Army Medical Museum, is a cast of his face in repose. The left side is absolutely paralyzed. The inner canthus of the left eye is a little rounder than that of the right eye. The tears overrun the lid at times. Inability to close the lids on the left side, owing to which he has formed the habit of rolling the eyeball upward so as to cover it with the passive lid. He then supposes that he has closed the eye. Chewing on the left side causes pain in the teeth, which endures for some time. Sensation is perfectly normal on the paralyzed side. Motion is of course utterly lost in all the muscles of expression. Electric test: Not the slightest contractility exists in any of the muscles of expression on the left side, with a curious exception. The muscular layer of the orbicularis oris in the upper and lower lips still responds to the current, but more remarkably below than above. There, is, however, no voluntary control over these parts. The buccinator alone of the masticating muscles seemed to have its electric contractility enfeebled but not wholly lost. Examination of Special Senses-Tongue-Motions: The upward and backward motion of the base of the tongue is awkwardly performed. In most of its movements the tongue inclines slightly to the right side, and is capable of being drawn to the left side. The palate hangs a little to the right and acts imperfectly, so that food is apt to enter the nose. There is some further loss of power in the other muscles of deglutition, for he is often troubled by food entering the glottis, while at times it is thrust back again into the mouth. Speech: He pronounces many letters with difficulty or imperfectly, so that his speech may be said to be a little thick, and he so describes it, referring the trouble to his lips and tongue. The labials are of course affected, but the guttural sounds are also imperfectly executed. Taste is apparently impaired over the entire left tongue. It was examined by comparing its appreciations with those of the other side. Electric state of Tongue: No loss of its electric properties was detected. Hearing on the left side was destroyed. The back part of the bony meatus was carious and the membrane absent, perhaps from inflammation consequent upon the wound. Treatment: The patient was industriously faradized for several months without the least gain in any respect. The nerve may have undergone such changes as might make it impossible to restore to the muscles their lost properties. Dyre was discharged from service July 2, 1864, and pensioned. Examiner T. F. Harper, of Philadelphia, reported, January 30, 1869: "A gunshot wound in petrous portion of temporal bone of left side of head, causing superficial fracture followed by some exfoliation of bone. There has resulted a paralysis of seventh nerve, occasioning an impairment of vision of left eye; also a great deformity of the face, it being much contorted and twisted to the right by loss of power in the muscles of the left side of the face." The Philadelphia Examining Board reported, September 13, 1877: "Paralysis of left side of face, with loss of hearing, left ear, and defective sight in left eye. Deformity, overflow of tears, and inability to close eyelids. Ball supposed to be in temporal bone."
Gunshot wounds, and other injuries of nerves. By S. Weir Mitchell, M. D., George R. Morehouse, M. D. and William W. Keen; publisher: Philadelphia, J. B. Lippincott & co., 1864.