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

84 INJURIES OF NERVES.
regions of the hand, for example, and that many
of its
parts are stirred by more than one muscle or set of
muscles.
In examining the sensibility, too much care cannot be
observed, since there is a natural instinct which causes us
to use any power of motion we may have in order to press
upon and so examine the touching body. Care as to these
points, and minute attention to the anatomical distribution
of nerves, will usually decide the extent to which a
nerve may have been divided, where the accident is a
simple incision. Although there is a general impression
that a clean cut of a nerve, partial or complete,
is
likely to result in total restoration of function, I am sorry
to state, as my own experience of such cases years after
the accident, that the histories of entire restoration are
sadly rare, and that most instances of divided nerves, if
abandoned to themselves, result in deformities and functional
losses such as characterize, though in far graver
degree, gunshot lesions. I suspect that tlie experience
of most physicians will support me in this statement
which is
amply sustained by Mr. J. Hutchinson's* series of
of which were glass wounds, resulting
histories, nearl}' all
in serious and lasting loss of sensation or motion, with
marked nutritive changes.
Among cases of this nature,
of which I have seen
several, but always late in their history, the burning pains
are certainly more rare than in wounds by missiles, 3'et
they are not altogether wanting, as Mr. Paget's cases show.
The two following examples may answer as illustrations
of this class of injury and of the consequences which
are apt to follow it. In these, as in other neural lesions,
the nerve section is certainly followed b}^ the usual degeneration
of the peripheral end, just as is seen in animals.
* Clinical Lectures and Eeports, London Hospital, 1866.