Injuries of nerves and their consequences - Reflex Sympathetic ...

SYMPTOMATOLOGY OF NERVE LESIONS. 137
ill the testicle, which was retracted during several
hours.*
For reasons not altoo:ether clear, some neck wounds
cause at the moment horrible pain
at the insertion of the
deltoid, which may possibly be due to a sudden spasm
of this muscle. Commodore Stembel, whose case I have
elsewhere related,t was shot in the right side of the neck,
and had pain iu both arms. Another officer, struck by a
ball in the right thigh, felt pain only in the left limb, and
throughout suffered most in that part.
Where a nerve of mixed function is slightly injured
by contusion, the first impression is most felt by the
sensory branches, and any motor loss is
apt to be due to
secondary changes. In graver lesions, as by bullets,
sensation and motion are usually both lost at first,
even if the ball merely grazes the nerve, so that at the
outset of a case it cannot be known whether a ball may
have divided a nerve or merely stunned it completely.
At all events,
it is common to see the functions return
iiig after what seem to be serious lesions, some parts
until at last
recovering quickly and some more tardily,
we are able to decide as to what are to be permanently
damaged, where motion is gone, and where sensation
is lost.
* There is a region of skin on the thigh, extending from the groin
nearly to the knee, and capable of accurate delineation, which has certain
relations to the scrotum and testicle. Galvanic or mechanical irritation
of this area usually causes retraction of the corresponding testicle.
It is best seen in young people, and is of value in determining the presence
or absence of reflex transmissions in the thigh. The sympathetic movement
and pain in the testicle in the present case were curious illustrations of a
regional relationship which has perhaps not been elsewhere pointed out,
and which certainly is not well known or made use of for diagnostic purposes.
t New York Med. Jour., 1866.
Paralysis from Peripheral Irritation,
p. 49. S. Weir Mitchell. 10