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

70 INJURIES OF NERVES.
connective structure of the nerve; and also, as a rule, the
morbid change tends to march from extremity to centre,
rather than outward. The result of these alterations is
a gradual increase of connective white fibrous tissue, a
consequent thickening of the sheaths, and finallj^, a more
or less complete atrophy of the nerve tubes, involving
chiefly the white substance of Schwann, and leaving the
nerve fibre a mere rod, hardly to be distinguished from
the more wavv fibrous tissue about it. This destruction
is rarely complete throughout the nerve, so that nearly
always nerve tubes in every state of health and degeneration
can be seen within the area of a single inflamed
and hardened nerve. I have thus met with perfectly
healthy tubes in a nerve which was as tough as a tendon.
"With every appearance of enlarging, such nerves are
actually undergoing atrophic changes as to their proper
tissues.
Increase of bulk, proliferation of connective tissue, and
wasting of nerve tubes are common consequences of
chronic neuritis; but sclerosis may also be brought about
without the intervention
of inflammatory conditions, or,
at all events, the change which began in these may increase
and continue long after they
have faded or disappeared.
Sclerosis without inflammation undoubtedly
occurs in the nerve tissues of certain stumps where their
nerve trunks are enlarged and hardened, but neither
tender nor neuralgic. I have recently seen with Dr.
Mears a patient whose hand was removed by Dr. W. L.
Atlee, on account of a remarkable train of symptoms,
which, beginning with local spasms in this part, resulted
in typical epileptic fits. The median and ulnar nerves
were three times their natural size, and as hard as tendons.
Besides an immense proportion of fibrous tissue and degenerated
nerve tubes, there were still many of the latter
in an uninjured condition. The tenderness over the