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

DIAGNOSIS AND PROGNOSIS OF INJURIES OF NERVES. 227
To determine the future fate of the limb, we resort
to Du-
the induced and galvanic currents. If, according
chenne, a muscle moves ever so little when faradised at
a period thus remote from the wound, there is a fair
to
— chance of its recovery, a chance which lessens in pro-
with which it contracts under this
portion to the difficulty
stimulus. If, however,
a muscle neither moves nor feels
the pain of the current, this is an indication of so complete
a separation from the centres,
that from three
months to a year may elapse before the probability of
nerve restoration becomes such as may enable us to call
the part into action. This refusal to respond to the faradaic
current does not imply a certain loss of ability to act
under galvanism,
or of such mechanical irritation as a
smart tap. In grave cases, however, there comes a period
form of excita-
when the muscle may be dead to every
tion, and even to the direct eti'ects of galvano-puncture.
My colleagues and myself had many chances of testing
the value of these means, and finally
we learned to rely
upon them with the utmost confidence.
The sensibilitv is to be examined with the electric
brush, and if found, after two or three sittings,
to be
dead to this most intense irritant, we may safely conclude
that the nerves of the part are absolutely cut off from
their central connections, and will require long periods
for their repair, should this be ever possible. Unhappily
the future dangers of the case do not end here. Apart from
the chance of neuritis, which is, I am sure, a more common
sequence than has been supposed, there is no time
for some weeks after the healing of the original
wound
to suffer from neuralgia or
when the part may not begin
causalgia of indefinite duration, and from those obstinate
arthritic states which so baffle our efforts to restore movement
even when the healed nerves have made this otherwise
possible.