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

REMOTE SYMPTOMS. 157
Mr. Paget describes this state of skin in the following
language: " Glossy lingers appear to be a sign of peculiarlj-
of the
impaired nutrition and circulation due to injury
nerves. They are not observed in all cases of injured
nerves, and I cannot tell what are the peculiar conditions
of the cases in which they are found, but they are a very
notable sign, and are always associated, I think, with distressing
and hardly manageable pain and disability. In
well-marked cases, the fingers which are afiected (for
this
appearance may be confined to one or two of them) are
usually tapering, smooth, hairless, almost void of wrinkles,
glossy, pink, or ruddy, or blotched as if with permanent
chilblains. They are commonly also very painful, especially
on motion, and pain often extends from them up the
arm. In most of the cases, this condition of the lingers
is
both in them and
attended with very distinct neuralgia,
in the whole arm, and its relation to disturbance of the
nervous condition of the part is, moreover, indicated by
its occasional occurrence in cases Avhere neuralgia continues
after an attack of shingles affecting the arm. In
two such cases I have seen this same condition of the
lingers w^ell marked, and only very slowly subsiding, and
seeming unaffected by the ordinary treatment of neuralgia."
The following quotation from the work of Drs.
Morehouse, Keen, and myself, describes the malady as it
appeared in numerous cases in our own wards:
" Glossy skin.— The skin affected in these cases was
deep-red or mottled, or red and pale in patches. The
epithelium appeared to have been partially lost, so
that the cutis was exposed in places. The subcuticular
tissues were nearly all shrunken, and where the palm
alone was attacked, the part so diseased seemed to be a
little depressed and firmer and less elastic than common.
In the fino-ers there were often cracks in the altered skin,
and the integuments presented the appearance of being