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

162 INJURIES OF NERVES.
stage to be slower than that of the correspoudhig healthy
parts, although in no instance have I met with a total cessation
of growth. In lesser nerve wounds, ulceration
around the nails is common, and often very painful but
;
in connection with the gloss}' skin of certain neural lesions,
we observed peculiarities of nails and hair which we described
as follows :
"
When the depraved nutritive state has lasted for some
months, the hair commonly disappears from the fingers
afiected, and the nails undergo remarkable alterations.
They suffer only in the fingers the neural supply of which
has been interfered with, so that the nails in the median
distribution may be contorted and those in the little finger
be unaffected. The alteration in the nail consists of a
curve in its
long axis, an extreme lateral arching, and
sometimes a thickening of the cutis beneath its extremity.
In other cases a change takes place which is quite pecu
liar, and which to us, at least, was new. The skin at that
end of the nail next to the third finger-joint
becomes retracted,
leaving the sensitive matrix partly exposed. At
the same time, the upper line of union of skin and nail
retreats into or under the latter part, and in place of a
smooth edge,
is seen through the nail as a ragged and
notched border. The patient who presented these changes
in the most striking form had also lateral arching of the
nail, but no longitudinal curving. It was a case of the
most terrible suffering, from a combination of burning
pain in the hand and neuralgic pain in the forearm.
" No deformity of the nails in tubercle at all
approaches
that which nerve wounds occasion. Indeed, we think it
would be possible for one familiar with these cases to diagnose
the existence of a nerve lesion from the form of
these protuberant and oddlj'-curved nails.
"
When the nails of the toes have been attacked, and
they are very rarely so, the is
curving less marked, but a