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

338 INJURIES OF NERVES.
their extent; but the lad had become wear}-, and gave
me unsatisfactory replies.
I could onl}- learn that there
was sensory loss, but was unable to determine its exact
area.
The lid was moveless, except when feebly stirred by
extreme effort of the supra-ciliary muscles, and the eyeball
projected from its socket. When the vapor of vinesrar
was allowed to enter the left nostril, he knew it at
once and named it,
but the right had no perception of it
either as an odor or an irritant, and such was also the
case as regards mustard. I inferred from this that
probably the nasal ophthalmic branch of the fifth had
been injured; but the sectio cadaveris proved that both
this nerve and the olfactory had been destroyed, so that
neither irritations nor odors were readily felt.
The patient became comatose by degrees, and died on
the third day, when the conditions above described were
found to exist. The symptoms presented by the eye corresponded
to the lesions demonstrated after death. The
dull, insensible, and slightly-clouded cornea, the supraorbital
and nasal anaesthesia were due to the lesion of the
fifth nerve ;
the motionless eye and fallen lid, with the
non-secretion of tears and the projection of the eyeball,
depended on the section of the oculo-motor and the fourth
and sixth nerves; and the absence of smell was owing to
the injury to the fifth nerve and the subsequent pressure
upon the olfactory bulb.
The lenticular ganglion being undisturbed, our experiments
on the effects of Calabar bean and atropia have but
a limited physiological value, and only prove that extreme
contraction and dilatation of the pupil are possible
after
total section of the fifth and third nerves, posterior
to that body.
Case 66.— Gunshot wound of the inferior dental branch of