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

232 INJURIES OF NERVES.
Two weeks later, these changes ceased, and he began to
improve so rapidly that, except the exhibition of small
doses of arsenic and local frictions, there was no occasion
for more active treatment. I believe that this rapid relief
was largely due to the coming on of warm spring weather.
"When last I saw him, early in the summer of 1865, he
was suffering trifling pain in the arm at rare intervals.
There was no pain in the shoulder, but the deltoid was
still a little flattened, and the extended arm could be
raised only to the level of the shoulder.
Looking
at the anatomical relations of the musculospiral-to
the circumflex nerve, it seems fair to infer that
the disease which first involved the former came finally by
direct propagation to affect the latter. So far as the mere
symptoms can inform us, such would seem to be, in this
case at least, the true explanation of the secondary affection
which fell
upon the shoulder. ISTo opportunity has
been afforded me of studyijig the morbid anatomy of
nerves supposed to be thus altered ;
but I think the facts
in favor of directly propagated nerve change are quite
sufficient to render probable the theory I have here advocated,
while for the idea of its being a reflex affection,
there is simply no evidence at all.
The changes which finally occur in sensation and motion
from contusions or compression, diff'er in no important
respect from those which arise out of direct injuries;
so that for the treatment of these sequelae I may refer the
reader to that portion of this chapter in which I have
dealt with the therapeutics of symptoms.
Punctured nerves; wounds of superficial branches.— Punctured
wounds of nerves demand no especial treatment
unless they occasion grave symptoms, which is
by no
means alwaj's the case. They are, moreover, verj^ rare.
1 saw, some years ago, a woman who had transfixed the
median nerve with a steel fork. The injury at once