Injuries of Nerves and Their Consequences

time, rarely executed any violent or wide movements; but the forearm was much the same as his letter described it to have been in April. A greater gain was visible in the chest, neck, and trunk, the muscles of which no longer twitched. His general health was better, and he had become quite robust. I desired him to renew the treatment as soon as he was at rest in any one place, and hoped to persuade him at a future period to allow of some such operation as I have alluded to above.

I have heard of Colonel P. very recently, and learned that he has still the same movements, but is otherwise. in perfect health.

I alluded in the medical volume of "Sanitary Reports" to a case of chorea following amputation of the thumb, but have, unfortunately, no notes of it. The choreoid motions extended from the intrinsic thumb muscles to the arm and shoulder, and after a year or more became limited again to the forearm. The patient was cauterized, blistered, treated by setons, and by an endless variety of drugs, without avail.

Full doses of the bromides seemed to be of some use in Colonel P.'s case. In the localized chorea of adults, I cannot boast of success with these drugs, with any form of electricity, or with other means of treatment, and there seems to me to be much resemblance between these cases and the no less persistent form of chorea in stumps.

To this obstinacy in the face of all therapeutic interference I can make but one exception. An officer had incessant movement of the biceps muscle of an armstump. The spasm was annoying, but rarely violent, and was limited to the upper two-thirds of the muscle, the line of amputation having passed through it. In this case, daily injections of atropia ( to grain) into the mass of the muscle, entirely relieved him after nearly twenty such applications.

I think that it would be justifiable in these cases to divide the nerves concerned in the motions; but I should feel cautious and anxious about any such operation, having seen two instances in which operations for other causes proved fatal in adult chorea.

Choreal spasms with neuralgia.—There are also examples of chorea in stumps associated with intense pain, and it is not uncommon to find that in certain persons the rare spasmodic movements of stump muscles are accompanied by neuralgic paroxysms, just as happens in certain facial tics, and more rarely in such instances of general neuralgia as I have described elsewhere.*

A distressing example of this combination is related. by Mr. Langstaff. The forearm of a woman was removed on account of neuralgia from injury, and, healing with difficulty, there ensued a constant state of convulsive action in the stump muscles with agonizing pain. A great variety of treatment failed to relieve her. The skin over the bones was red and sore, the arteries beat with extreme violence, frequent convulsive fits followed, and her general health gave way. The limb was finally reamputated above the elbow, when the nerves were found to be greatly enlarged and to end in the stump in the usual button-like growths. Entire and continued relief was obtained by the operation.

* Reports of Philadelphia College of Physicians, 1869.
Med.-Chir. Trans., v. xvi. p. 140.

INDEX.

ABERNETHY,
nerves, 89.

lancet wounds of Atropia in spasm, 258.

Acupuncture, 268.
Esthesiometer, 183.

difficulties in using, 183.
Agnew, D. H., pressure by bursal
sac, 122.

dislocation causing palsy of
arm, 102.

exsection of ulnar, 296.

Alison, Scott, hemiplegic arthritis,

169.

Althaus, brachial palsy, 128.

used with morphia, 271.
useless in traumatic pain, 270.
Autogenesis of nerve not proved for
man, 85.

Autogenetic repair of nerves, 80.
Axis, cylinder, 17.

Bachon, palsy from malposition
when drunk, 130.

pressure of water vessels causing
palsy, 132.

Amounts of nerve injury, how Ball, cause of rheumatism, 169.

learned, 83.
Amputations, 346.

delusions as to motion follow-
ing, 357, 358, 359.
delusions as to place of lost
limb after, 353, 354, 355, 356.
for neural pain, 285.
functional changes after, 342.
lost parts felt after, 350.
sensory delusions after, 348.
Anæsthesia, 181.

electrical treatment of, 249.
Analgesia without anesthesia, 192.
Anatomy of nerves, 13.

Aneurisms, pressure on nerves by,
120, 121.

Annandale on glossy skin, 159.

Anomalies in nerves, 241.

Arloing and Tripier, 239.

ralgia, 280.

Banks, W. M., wounds of digital
nerves, 91.

Bärensprung on herpes, 35.
Bastien and Vulpian, results of press-
ure on nerves, 108.
Batteries, 248, 249.

Beale on terminations of nerves in
skin, 18.

nerve endings in muscle, 21, 22.
Becquerel, disks of, 174.

Bellingeri, hair changes from nerve
wounds, 164.

Bérard, case, 92.

Bernuilly, tumor of pelvis causing
palsy, 126.

Bert on grafting of tissues, 47.
Bianchi, palsy, in delivery, 123.
Bigelow, H. J., rhigolene, 57.
Blisters in causalgia, 273.

Arsenic useless in traumatic neu- Brinton, J. H., pressure of rein

Arthropathies, 169.

from central lesion, 259.
Atrophy of skin, 155.

muscular, pathology of, 150.
with contraction, 206, 252.

causing palsy, 131.

Brown-Séquard on trophic nerves,

34.

(369)

Burning pain, seat of, 196.

theory of, 199.

Callender on fractures causing nerve
injury, 106.

Callus, pressure from, 116.

with inflamed nerves, 120.
Calorification, effect on of nerve
injuries, 173.

Cancer, pressure on nerves by, 120.
Case of nerve wound from bone
splinter, 106.

of arthritic lesions from nerve
wound, 171.

of arthropathies from lesion of
spine, 259.

of brachial palsy from dislo-
cated humerus, 101.

of cancer pressing on nerves,
120.

of causalgia, 199, 273, 278.
of causalgia, amputation, 295.
of chorea of stump, 363, 364.
of compression by callus, 117.
of contusion of ankle, 209.
of contusion of brachial plexus,
96.

of contusion of median, 96.
of contusion of musculo-spiral,
230.

of contusion of ulnar, 95, 312.
of crutch palsy, 133.

of early return of function after
nerve wound, 138

of epilepsy from sclerosis of
nerves, 70.

of exsection, median and ulnar,
292.

of axillary nerves, 302.
of ext. ant. thoracic, 314.

of facial, 327, 329, 331, 333, 338.
of facial palsy, 128.
of glossy skin, 159.

of glossy skin from central
lesion, 160.

of hypertrophy from nerve
lesion, 167.

of injury of ulnar, exsection,

295.

of left hypoglossal nerve, 335.
of median, 165.

of median exsection, 298.
of median and ulnar, 209, 207.
of musculo-spiral nerve, 189.
of nerves of tongue, 216.

Case of neuritis, 63, 64, 65, 311.
of palsy from sleeping on arm,
129, 130.

of palsy of extensors from dis-
location, 103.

of post-partum paralysis, 125.
of sciatic, 308, 309.

of sclerosis of nerve, 285.
of section of median, 85, 240.
of section of ulnar and median,
252.

of Swan, nerve wound from lan-
cet, 90.

of sympathetic, 318.
of tonic spasm, 304.

of typhlitis affecting sciatic,

221.

Chorea, 148.

Chorea and neuralgia in stumps,
368.

Chorea of stumps, 363.

checked by emotion, 347.
treatment of, 367.

Cicatrices, pressure from, 115.
Clavicle, fracture of, causing palsy,
105.
Claw-hand, 255, 256.
Cold, dry, in pain, 272.
Cold, effect of on stumps, 345.
effect on nerves, 54.
in neuralgia, 267.
Compression of nerves, 107.
during labor, 123.

Compression, treatment of, 229.
Conductors, use of, 247.

Congestion, artificial, of nerves, 57. | Electricity, 246.

Congestion of nerves, 56.

results of, 57, 58, 59.

Conia, use of, in neuralgia, 270.
Connective tissues, trophic change
in, 166.

Contracting muscles, 206.
Contractions, 256.

Contusion of nerves, 92.

results of, 94.
symptoms of, 94.

treatment of, 229.

Counter-irritation, 266.

in neuralgia, 267.

a test of loss of function, 244.
early use of, in nerve wounds,

246.

form of current, 246.

influence of on stump nerves,
349.

in prognosis, 227.
in diagnosis, 220.
in arthropathy, 259.
mode of using, 248.

Emboli, pain from, 52.

Empis, cause of injury in disloca-
tions, 100.

Crampton, increase of hair from Erichsen, temperature after nerve

neuritis, 164.

Crutch palsy, 132.

Cylinder axis, persistence of, after
section, 77.

Danielson and Boeck, 116.
Daturia, use of in neuralgia, 270.
Day on neuro-traumatic rheuma-
tism, 168.

on spinal rheumatism, 168.
Defects of sensation, 181.
Deformities from muscle changes,

251.

lesion, 174.

Eruptions,

cutaneous, following

nerve wounds, 153.
Eulenberg and Londois, nerve
suture, 242.

Fæces, accumulation of, a rare cause
of palsy, 126.

Faradisation in anæsthesia, 265.
of stump nerves, 359.
Femur, nerve injuries from its frac-
tures rare, 106.

Ferréol-Reuillet, nerve wounds from
fractures, 104.

Flaubert, nerves injured by disloca-
tions, 98.

Forceps, pressure by, causing palsy,
127.

Fractures of bones causing palsy,
104.

Freezing of nerves, 58.

congestion which follows, 59
thermal symptoms in, 60, 177.
Fromman and Grandry, structure
of nerve fibres, 17.

Galli, tubes of, 242.
Galvanism, 246.
Glossy skin, 156.

Morehouse and Keen on, 157.
seats of, 158.

Granger, fractures causing palsy,

104.

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