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

g Swan, case, p. 117. 7
VARIETIES OF MECHANICAL INJURIES OF NERVES. 89
Abeniethy,* Mr. Swan,t Hamilton,^ and others relate
numerous instances of such accidents with more or less
disastrous consequences than chanced to Fare's royal
the most
patient. These are in many respects among
curious histories of nerve wounds with which I am acquainted,
and would lead us to suspect that more extensive
r^ex symptoms are likely to be aroused by wounds
of small cutaneous nerves than bv those of larw-er trunks,
and perhaps also that certain central conditions are needed
to determine the grave symptoms which in numerous cases
of slight nerve wounds are altogetlier wanting.
iSTowadays these injuries are so rare that in my own
experience I can recall but two, both of which date back
several years, so that for instances of this nature we must
resort to the older treatises.
Mr. Swan has detailed a number of slight wounds involving
small nerve branches. In some of them there
was instantly acute pain in the track of the nerve distribution,
which speedily subsided, while in others it
grew
more severe, until general convulsions resulted. In certain
cases the pain began
after some hours, and rapidly increased,
with the addition of hyperoesthesia, fever, local
twitchings, and general convulsive disorder, which in
very rare examples assumed an epileptic type.§
It is principally notable in these histories that the
gravest symptoms were due to wounds of small filaments,
few instances of like severe symptoms having followed
those of great trunks; a fact which accords, as I have
said, with what we now know of the larger capacity of
nerves for evolving reflex phenomena as they approach
* Surgical and Physical Observations. London, 1793
f Swan, op. cit., p. 110.
1 Hamilton, Jr., Dublin Journ. Med. Sci., March, 1838.