In October of 1864 the first dent in the armor of RSDS was made. Weir Mitchell and his associates G.R. Moorheouse and W.W. Keen published a book called "Gunshot Wounds and Other Injuries of Nerves".

This book contained the account of the symptoms and signs of peripheral nerve injuries as they had observed them in Unionist soldiers at Turners Alne Hospital for Nervous Diseases in Philadelphia. Their description is so classic and vivid that it deserves an abbreviated quotation here.

"In our early experience of nerve wounds, we met with a small number of men were suffering from a pain which they described as ‘burning‘ or as ‘mustard red-hot‘ or as ‘red-hot file rasping the skin‘ ... The seat of burning pain is very various; but it never attacks the trunk, rarely the arm or thigh, and not often the forearm and leg. Its favored site is the foot or hand.

In these parts it is to be found most often where the nutritive skin-changes are met with; ... Its intensity varies from the most trivial burning to a state of torture, which can hardly be credited, but which reacts on the whole economy, until the general health is seriously affected.

The part itself is not alone subject to a deep burning sensation, but becomes exquisitely hyperesthectic, so that a touch or tap of the finger causes pain. Exposure to the air is avoided by the patient with a care which seems absurd, and most of the bad cases keep the hand constantly wet, finding relief in the moisture rather than the coolness of the application.

As the pain increases, the general sympathy becomes more marked. The temper changes and grows irritable, and the face becomes anxious, and has a look of weariness and suffering. The sleep is restless, and the constitutional condition, reacting on the wounded limb, exasperates the hyperestic state so that the rattling of a newspaper, a breath of air, the step of another across the ward, the vibrations caused by a military band, or the shock of the feet in walking, gives rise to an increase of pain."

Message from Keith

Three years later, Mitchell first used the term Causalgia (from the Greek kausis-burning and algos-pain). It was right on the money then, and still is today. What is sad though, is that we don‘t know much more now than we did then !