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

168 INJURIES OF NERVES.
was dry, scaly, and yellow. The enlargement affected
but it also
principally the thumb and tirst two fingers,
involved the back of the hand, which was most developed
on the radial side, the thumb being more remarkably
overgrown than the other parts. The ulnar side of the
palm and the back of the hand were a little oedematous,
but in the regions above mentioned the skin seemed thickened,
and the tissues were as firm as most fibrous tumors,
and did not pit upon pressure. Dr. Packard, who also
saw this patient, pointed out its extremely close likeness
to elephantiasis.
— Alterations of joints. Of all the various forms of mischief
wrought by nerve wounds, the most intractable and
disabling are the curious inflammatory states of joints to
which we were the first to call attention.
The relation of rheumatic lesions of joints to neural
injuries of centres is so interesting in its connection with
our own observations that I shall be pardoned if I allude
to its history.
In 1831, my father, the late Dr. J. K. Mitchell, described*
four cases of spinal injury, which were, followed
by inflammations of joints below the point of spine
att'ected. Upon these he based a pathogenesis of rheumatism,
which connected it with afl^ections of the spinal
centres. Since then, numerous theories of the cause of
rheumatism have held sway, each in turn to fall before
more strict analyses and later facts. In 1864 our demonstration
of the relationship of joint diseases to nerve wounds
again called attention to this view of the subject. It received
favorable consideration at the hands of Dr. Day,t of
Stafford, England, in an able volume of clinical histories,
in 1866, and in the same year was carefully discussed by
* Amer. Jour. Med. Sci., vol. viii. p. 55.
f Clinical Histories, Dr. Day. London, 1866. i