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

152 INJURIES OF NERVES.
may alight upon this and on the nutrient system of the
skin at one and the same time. I have yet to see a distinct
case of nerve wonnd atlectino; the latter siusflv, without
sensory or motor disturbance.
The mode in which nerve wounds attack the cutaneous
nutrition, whether directly, by irritations of fibres leading
to the part, or reflectively, through the centres, and by
uninjured filaments upon the skin, is often, nay, generally,
diflicult to determine but since in total nerve
;
section
we more rarely observe such grave disasters to skin
nutrition as follow partial lesions, it is likely that reflected
irritations have their share in the mischief; yet
there is reason to believe that in one large class of skin
disease arising out of nerve wounds,
the irritation is direct
rather than of reflex parentage.
The nature of the irritation which arises in nerve wounds
is somewhat doubtful. It is very rare that any of the
peculiar nutritive changes occur early. They are more
liable to arise with the inflammatory state into which most
wounds are apt to fall, or they follow the injury even
more remotely, as in contusions. We may, therefore,
suspect neuritis or sclerosis as frequent causes of mischief.
In one case I saw a sudden access of inflammation in a
healing wound over the injured median nerve determine
an immediate outbreak of neuralgia, ulcerated matrices
of nails, and vesicular eruption ;
while in another, a
wound of the radial, an attack of erysipelas brought about
causalgia (burning pain) and glossy skin, with eruptions,
the patient having previously only some loss of motion
and sensation. I have already stated that complete section
of the nerve of a limb caused general atrophy, with
oedema, and finally discoloration of the dry and thickened
skin, the ragged epithelia hanging in patches.
these conditions are, no doubt, due to want of use.
Some of
Cases of this kind are, however, very rare, and do not