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

226 INJURIES OF NERVES.
of sensory skiu filaments have been held to support the
opinion I am combating, but probably the pains are due
to reflex radiated irritations; nor is there the slightest
proof, on the one hand, that such irritations may not arise
from the ends of fully divided nerves, nor, on the other,
is there any evidence that in these cases the minute nerves
in question are merely pricked or half-way severed. It is
certain, however, that partial nerve wounds of large trunks
alone occasion man}' of the distressing nutritive conditions
already described ; but, so far as my experience goes,
notwithstanding these results, such wounds have, on the
whole, a more fortunate remote history than thoroughly
divided nerves, where a missile of war has been the injuring
agent.
The future of cases
of entire severance of nerves will
depend upon the amount of nerve cut away, the sequent
neuritis, and the fate of the surrounding tissues but even
;
when the portion lost has been an inch or more, we should
not absolutely despair of a large return of function, when
we remember the extraordinary regeneration of nerves
after exsections for neuralgia.
Given a case of severe injury to a large nerve, how shall
we make up our minds as to the probable
future of the
is of
parts over which it presides No ? early opinion
value. All missile wounds bruise and disturb more nerve
This is why many muscles, which
filaments than they cut, and these will, in a few days, recover
their lost powers.
at first seem paralyzed, come again very early under
volitional control. The extent of anaesthetized skin of
most nerve wounds also lessens within a week. Gradually
with the absorption of blood, if no neuritis interposes,
these happy changes continue until, at last, in from a month
to six weeks, we begin to be in a condition to judge what
muscles are to be more permanently palsied,
what skin
spaces are to remain insensible.