A CASE OF INJURY TO THE MEDIAN NERVE ILLUSTRATING THE POWER OF REPAIR OF A MIXED NERVE TRUNK; AND THE MODE OF ACTION OF PILOCARPIN

THOMAS D. SAVILL
1893 Brain  
IN Infirmary practice one often has the opportunity of observing a patient over a long period of time, and the following case, which has been under my notice for nearly six years, may be interesting. It illustrates the power of repair of a mixed nerve trunk, where the injury is of a very definite and known extent. Daniel Plynn, who was then 20 years of age, a bargeman, was admitted to the Paddington Infirmary on September 20th, 1887, for tetanus. The case was one of extreme severity, and as
more » ... e was a clear history, 14 days before admission, of injury to the palmar twigs of the median nerve by falling on a dust heap, it was thought that division of the nerve might possibly give him an additional chance of life. Accordingly upon September 28th, 1887, half-an-inch of the median nerve trunk in the upper arm was removed, the two ends being loosely connected by cat-gut, leaving § of an inch interval. The wound healed by first intention; and this operation was, of course, followed by paralysis of the muscles, and anaesthesia of the skin supplied by the median nerve. These symptoms, it was hoped, would pass off after the nerve had re-united. But it was not so ; the weakness of the muscles increased, they became atrophied, and presented marked reaction of degeneration. At the end of three months (Dec, 1887) blebs formed spontaneously on the knuckles of index and second fingers of the right hand. These blebs soon became open sores (and did not heal for any great length of time during the next 13 months, fig. 3 ). About this time, also, it was noticed that the skin over the outer half of the band was rougher and redder than that over the inner,
doi:10.1093/brain/16.3.452 fatcat:m6rfucdgzzen5jjp7cnu6q7ax4