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

SEXSORY LESIONS. 195
immediate cause in the region of ultimate nerve supply.
In this manner are produced, as T believe, the horrible
pains of causalgia.
The neuralgias common to all nerve injuries, and
which I desire clearly to distinguish from causalgia, with
which I should add they may coexist, are apt to affect a
quotidian type, and to occupy, as a rule, the latter rather
than the earlier hours of the day. It is curious, and as
yet unnoticed, that the pain of non-malarial neuralgia
and of neuritis and neural sclerosis never assumes a
tertian or any other than a quotidian type. It is quite
rare for a patient to arouse frem sleep with pain, and I
have heard men remark that it took some time to get
awake to the pain. This is familiarly illustrated where
the toothache of the last night does not come on next
day until exercise has stimulated the circulation. The
tendency to intermit or remit in ordinary neuralgias frequently
causes them to be ascribed to malaria; but the
same tendency
is seen in traumatic cases, or in the pains
caused by pressure on nerves, as from aneurism, but is
much more rare in those which I class*" as causalgia,
and in which the pain usually appears at the time the
man awakens and pursues him with increasing torture
throughout the day.
Mr. Swan relates some curious instances of traumatic
pain of an intermittent type. In one, an ulcer over the
peroneal nerve occasioned a pain which recurred daily at
the same hour, and I have myself seen numerous instances
of pain from direct injury where this condition
was met with. Usually the pains from nerve hurts are
either aching, shooting, or burning, or perhaps all three
at once Looking carefully through my notes as to this
point, I find that in a considerable proportion of gunshot
wounds of nerves there is principally burning pain, or at
least that this is the prominent symptom, while in slight