1870.] On Trophic Nerves. 203 



following -wounds of nerve-trunks. The appearance of the skin in 

 this condition has been likened by Mr. Paget to that of chilblains. 

 The integument becomes red and polished, in spots or patches. The 

 hair is wanting. Sometimes the sensibility remains as usual ; some- 

 times it is increased ; sometimes diminished. The case cited as 

 exceptional is curious enough. A man received a bullet wound, 

 apparently implicating the axillary artery and musculo-spiral and 

 median nerves. ' Very early in the case his first and second finger 

 and thumb slowly enlarged without any premonitory signs, and 

 with slight darting pains.' This continued after the wound had 

 closed. Two months after the wound the skin of the affected part 

 peeled off en masse. Seven months after the injury, when the case 

 was last seen, sensation was wanting in the first, second, and half of 

 the ring finger, and in the half of the thumb, though neuralgic 

 pains were referred to these parts. The palm and first two fingers 

 were enlarged. The skin was thickened, and of a dark purple 

 colour. It is not surprising that the American surgeons should be 

 struck by the resemblance between this and the disease called Ele- 

 phantiasis Arabum. While in India, we have several times seen 

 two or three fingers enlarged to twice the size of the others, and 

 the skin pink and glossy, contrasting with the black skin of the 

 rest of the hand. 



" Other lesions of nutrition or secretion following wounds of 

 nerves are also pointed out. Sometimes there were copious acid 

 sweats ; sometimes there was dryness or desquamation of the skin, 

 vesicular eruptions, or incurving of the nails, or subacute inflamma- 

 tion of the joints, favouring the conclusion that the lesion of the 

 nervous trunks acts upon the nutrition of the parts, independently 

 of the loss of sensation or motor power." 



The nutritional lesion at the peripheral distribution of the nerve, 

 however, may, if it persist sufficiently long, become in its turn the 

 causative condition of what was in the first instance but a result in 

 common with itself of the lesion of the nerve-trunk. For Dr. Mitchell 

 " claims the merit of having pointed out what was practically unknown 

 before his own researches, namely, that loss of motor power, in a vast 

 majority of cases, is finally due less to neural defects than to those 

 obstinate consequences in the range of nutrition which result from 

 the loss of nerve-power, and which may continue long after the motor 

 power has been partially or completely restored." 



Many similar cases may be found recorded by Mr. Jonathan 

 Hutchinson in a very valuable paper, consisting of " Observations 

 on the Results which follow the Section of Nerve- trunks, as observed 

 in Surgical Practice," which was published in the ' London Hospital 

 Reports' for 1866. Mr. Hutchinson is inclined to explain the phe- 

 nomena of lessened temperature and those of lessened power of main- 

 taining temperature which accompany these lesions, by the lessened 



