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

SYMPTOMATOLOGY OF NERVE LESIONS. 189
is known as "shock." This is
commonly described as a
condition in which the patient "becomes cold, faint, and
trembling; the pulse is small and fluttering; there is a
great mental depression and disquietude, incoherence of
speech and thought ; the surface becomes covered by a
cold sweat; there are nausea, perhaps vomiting, and relaxation
of the sphincters."*
Exactly such as are here described were the symptoms
of shock which followed nerve wounds. In nearly every
case there was more or less sudden feebleness, and in
some there was the most absolute and o-eneral loss of
power, accompanied in a certain number by insensibility,
probably due to syncope. We have nothing in this direction
to separate wounds of great nerves from those involving
only muscular and bony parts, and therefore
minute nerve fibres alone. Gunshot wounds, however,
present us with certain possibilities which are interesting
tests of the amount of shock, and which are not available
in such cases as railway injuries or in any which throw
a man down.
As to what percentage of men wounded through muscle,
or bone and muscle chiefly, suffer from shock, and
to what degree, I find no mention in surgical works, so
that I cannot compare my own statistics as to the immediate
shock from nerve injury with that arising from other
causes.
This state of shock, so well known to the surgeon, is
simply a reflex effect of the injury of nerves, large or
small. In general,
it affects in varying proportion all the
great nerve centres which preside over circulation, respiration,
and voluntary movement, and instantly brings
about such a condition as follow^s an overdose of tartar
emetic.
Its
symptoms and treatment are alike familiar,
* Erichsen's Surgery. Ed. by Dr. John Ashhurst, 1869, p. 121.