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

DIAGNOSIS AND PROGNOSIS OF INJURIES OF NERVES. 221
settle the question as to whether or not it was really cut
across; since if it were, it would be impossible, by this
agent, to excite its related muscles. It were also well in
cases like N^laton's or Nott's* to try if, by electricity
applied to the unharmed nerves, we could excite muscles
usually controlled alone by branches belonging to the
nerve injured. The results, whether negative or positive,
would be full of interest.
M. Tillaux has made some effort to point out how we
may distinguish the various forms of injury, as commotion,
contusion, compression, and partial section. Of course
the history of the injury may be such as to make needless
this inquiry but it often happens that, w'ith evidence
;
of functional loss or injury, there is some possibility of
intra-pelvic or other interior pressure, or else we may
have a history of mechanical injury with that of some
other probable cause of neural lesion.
As an example of this, I saw a short time ago a fine little
fellow, who had a slight dragging of the right leg, following
upon a fall. On inspection, however, I noticed that
the affected leg was the smaller, upon which a careful
questioning disclosed the fact that the child must have
halted a little for some time. Then, finally, I learned that
he had had, several months before, a severe attack of typhlitis,
with great swelling and hardness in the right pelvic
region. The fiill was too recent (forty-eight hours) to
have caused atrophy, which was very distinct. I con-
that the nerves must have suffered from
cluded, therefore,
the gradual pressure of the confined and engorged tissues
about and below the gut. Certainly no single symptom
of pain or numbness indicated the progress of the evil, so
that here, as in many other cases, a very gradual pressure
proved competent to occasion grave nutritive and some
* See chapters on Treatment.