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

236 INJURIES OF NERVES.
was slight feeling in the median distribution. At the
close of a mouth sensation was still very obscure in the
thumb and forefinger, and some parts of the skin were
insensible. A year having passed there was still no feeling
in the last phalanx of the thumb and forefinger,
but elsewhere in the median distribution sensation was
almost perfect.
The second lad had his hand so nearly cut ofi:' at the
wrist that it remained attached to the forearm b}' only a
portion of skin an inch wide, connected with which were
the unhurt ulnar vessels and nerve, and the flexor carpi
ulnaris muscle. The radial artery was tied, and the parts
having been replaced, the limb was dressed with adhesive
strips and put on a splint. In a week after the injury the
hand had become warm again, and in ten or twelve days
there was slischt sensation in thefino;ers, but in the thumb
none was discernible until more than two weeks had crone
bv. Fiuallv, the sensation of the hand and fino-ers, and
most of their movements, were perfectly restored.*
Tillauxf is inclined to explain these two cases as instances
of really rapid repair, such as Schift' describes as
occurring in young animals, and would not regard them
as examples of immediate union, with consequent escape
from secondary degeneration. In other words, there was
time here for such rapid partial alteration and regeneration
of the distal ends of the cut nerves, as has been shown to
be possible in the young of animals, while to constitute a
truly immediate union we should have so speedj^ a reunion
as to save the peripheral extremities frgm the certainty of
Wallerian atrophy of their tubes.
Perhaps the following observation may best illustrate
how unHkely
is immediate union to take place under even
* Paget, Surgical Pathology, Am. ed., p. 187. Phila., 1854.
t Op. cit., p. 89.