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

322 INJURIES OF NERVES.
also more permanent palsy of the right arm. I cannot
well conceive how the sympathetic of the right side could
have been directly hurt by the missile, yet there was
temporary loss of sight in the right eye, and even after
two years slight ptosis, especially in the morning, contracted
pupil, and imperfect vision, without unilateral
flush, but with defect of secretion of sweat in
the right
neck, arm, and chest, and with rather excessive perspiration
on the left side of the face and neck.
That there was some affection of the sympathetic in
this case seems most probable, but I incline to regard it,
like the other paralytic symptoms of this extraordinary
case, as due to a reflected irritation.
Dr. William Ogle has reported an instance of probable
destruction of the right cervical sympathetic by abscesses.
In this case the eyeball was retracted, the palpebral fissure
narrowed, the pupil contracted, the right side of the face
redder and hotter than the left during repose, but after
violent exercise or fever colder. The left side of the face
alone sweated, and the right side of the mouth and tongue
was complained of as being dry.
The symptoms observed in this case differed very little
from those of the history first quoted. In Dr. Ogle's case
there was wanting the droop in the outer angle of the
eye, which in Mooney was very apparent. The defect of
secretion seems to be a late symptom, and in neither was
no lachrymal lesion
there any notable nutritive alteration ;
or h3'pertrophy or change in the growth of the hair, such
as I have occasionally seen in animals. In all other
respects these cases reproduced the symptoms seen when
we divide the cervical sympathetic in an animal.
The subject needs further clinical illustration, and at
present nothing can be said as to prognosis or treatment,
while in most instances the diagnosis must be sufliciently
•clear.