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

148 INJURIES OF NERVES.
nerves divide and approach the skin. Brown-Sequard
succeeded once in causing tetanus, by leaving a rusty
tack in the foot of an animah I have never been able to
get this result by any method, nor in some seventy
sections of wounds of nerves in animals have I ever
encountered it.
Chorea, a still rarer consequence of nerve wounds, is
a very uncommon result of any wound, although I have
met with such cases, especially one in an adult, where
the ankle was slightly injured by a ball. Dr. Packard*
reports a case of chorea from injury to the terminal
filaments of the median nerve in the thumb. Exsection
of a sensitive point brought about relief and cure, which
all previous means had failed to effect.
I have seen no example of chorea from wounds of
large nerve trunks, but I have several times been called
upon to treat this malady in the stumps left by amputations
of the arm. Here, however, it is one of the more
remote consequences of changes in the divided nerves,
and is excessively rebellious to treatment. Beginning in
the stump, it is apt to be propagated to more distant parts,
so as finally to assume, in certain cases, a unilateral character.
I shall elsewhere have occasion to speak of the
tendency of muscles in stumps to twitch from excitement
or changes of weather, and to obey irregularly orders
directed by volition to parts in
the lost limb.
Later local symptoms.— Long after a nerve has been
bruised or wounded, there is apt to occur in the skin or
muscles to which it is related a double series of most un-
— manageable symptoms the one due to division of nerve
fibres and absence of nerve force, the other to irritations
of nerve fibres which are still more or less entire, and to
consequent disturbances of the nutrition and functions of
* Am. Jour. Med. Sei., April, 1870, p. 347.