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

194 INJURIES OF NERVES.
of the pains of neuritis. In many punctured wounds, the
whole nerve seems to be thrown suddenly into an hyperfesthetic
state, so that it continues to express irritation in
the shape of very agonizing pain. After a time, such a
nerve becomes congested or inilamed, and hyperplasia of
inter-neural connective tissue occurs, the pain
still continuins:
or 2;rowinf]c worse.
In cases of simple equal pressure on nerves, pain may
not be a prominent symptom, but will be most apt to be
felt severely when the pressure is varying from time to
time. Pressure, with inflammatory or cancerous alterations,
is the parent of most horrible forms of anguish, such
as we see so often in cancer, aflecting the pelvic and sacral
plexuses.
In gunshot injuries of nerve trunks, pain
may be continuous
from the outset, but more commonly the neuralgias
date from the time of the traumatic fevers, or even
still
later.
Early in this chapter I drew a distinction as to the
three methods in which nerve pains originate, and it is
again necessary here to return to the subject. In a
large number of cases, and in most of the pains of inflamed
or scleromic nerves, the pain comes from irritation
of fibres in or near the wound, the nerve tubes or the
centres becoming hyperfesthetic and the sensation being
referred to the peripheral tissues. But in
many instances
like pains arise, although the nerve be cut across, or the
member lost, as in stump neuralgias, there being still
the same reference of the pain to a supposed seat. The
important difference between these two conditions, both
fertile in torment, lies in the fact that when portions
of the fibres of a nerve are still
uninjured, but irritated,
certain nutritive mischief may be made in the peripheral
parts, and we may thus have evolved a peculiar type of
anguish, the remote cause of which is in the wound, the