ACCOUNT OF A CASE

WHERE A

SEVERE NERVOUS AFFECTION

CAME ON AFTER A

PUNCTURED WOUND

OF THE FINGER,

AND IN WHICK

LAMPUTATION WAS SUCCESSFULLY PERFORMED.

By JAMES WARDROP, Esq. F.R.S. ED.

Read Jan. 21, 1817.

PATHOLOGICAL researches on the nervous system, have been extremely limited, and perhaps less is known of the diseased changes of structure in the nerves, than of those of the other systems which enter into the composition of the human frame. The treatment of nervous affections is involved in equal uncertainty and obscurity. As in this state of our knowledge, the history of insulated cases acquires importance, the following account of a severe nervous affection which succeeded a punctured wound of the finger, and which was cured by amputation, may not be deemed unworthy of being laid before the Society.

SEVERE NERVOUS AFFECTION FROM A WOUND. 247

A respectable woman about forty-eight years of age, twelve months before she applied to me, pricked the fore-finger of her right hand, near the point, with a gooseberry thorn. It was immediately followed by a great degree of pain, swelling and redness, and in a few days the inflammation extended along the finger and adjoining phalanx of the middle finger. After continuing nearly three months, during which time no suppuration took place, the pain and swelling went off, except that of the two first phalanges of the wounded finger. These remained extremely painful, and about six weeks previous to the time I saw her, her general health had suffered considerably, and she was attacked with severe nervous paroxysms. The pain in the point of the finger became excessively severe, and the skin of it so acutely sensible that she could not endure it to be touched; even the dread of any thing coming in contact with it, would make not only the finger, but the whole hand flow with perspiration; and to use her own expression, "it was so painful to the touch, she could not hold a pin betwixt the finger and thumb, to save her life." The finger appeared of its natural form, and no change could be perceived in it, except a light red spot on the skin at the point.

The nervous paroxysms usually attacked her two or three times a day, and one of them always came on at the time of her rising out of bed.

During these attacks the pain extended along the finger to the back of the hand, and between the two bones of the fore-arm, darted through the elbow-joint, stretched up the back of the arm to the neck and head, producing a sensation at the root of the hairs as if they had become erect. To these feelings succeeded a dimness of sight, and the pain afterwards went suddenly into the stomach, followed by sickness and vomiting. She had constantly the feeling of a lump in her stomach, and always vomited after taking food or drink. Her flesh too was much wasted, and she had become extremely feeble.

During her illness various cooling and astringent lotions were used without any benefit, and seven months after the accident, three incisions were made into the point of the finger, which gave excruciating pain, but from which she received not the smallest benefit.

As well from her own suggestion as from the opinion I had formed of the disease, it was agreed on to amputate the finger, and accordingly this was done in the usual manner at the second joint,

On carefully dissecting the finger, no change could be detected in the structure of the nerves.

No sooner had she got into bed after the opera

tion, than she experienced a remarkable difference in her feelings; the sensation of a lump in the stomach, and sickness which she had so long felt immediately subsided, and in half an hour after the operation, she said that she felt for the first time as well as she had done previous to the accident, except merely a slight pain in the stump.

The greater portion of the wound healed by adhesion, and when I saw her some weeks afterwards, her general health was completely re-established, and she never had the smallest return of any of the nervous symptoms.

Of all those cases of diseased nerves, accompa nied with severe symptoms, whether produced from injuries or other causes, where an attempt has been made to alleviate the disease by a simple division of the nerve, there are but few instances where such treatment has been successful; and as in many of these cases the disease ultimately proved fatal, it becomes an important practical point to decide, where the disease affects a nerve of any of the extremities, on the propriety of amputating the limb, in preference to the mere division of the nerve; an operation which may on first considering the subject appear severe, but when contrasted with the patient's sufferings, and the danger of a fatal termination, may with much prudence be adopted.

The success of amputation where the affection is produced from an injury of the nerve, is illustrated in the case which has now been related, as well as in that published in the Fourth Volume of the Transactions of this Society *. Had the nerve been merely divided in this latter instance, as was originally proposed, and as was done in a similar case related by Sir Everard Home, in the Philosophical Transactions, it is extremely probable that the operation would have been attended with the same fatal result.

It has been proposed, but I do not know if the operation has ever been performed in this country, to divide the nerve of the finger affected in epilepsy, where the fit commences with an aura. The experience of medical men in dividing or in removing portions of diseased nerves might not have led to the anticipation of a favourable result from such an operation. I have, however, been informed by Dr. Mayer, an intelligent Hanoverian practitioner, that he saw in a case of epilepsy where the paroxysms came on with the aura, the little finger amputated and followed by a complete abatement of all the nervous symptoms.

These observations lead me to conclude, that in cases of injury of the nerve of a limb, followed by an affection of the nervous system in general, it is

* By Dr. Denmark, p. 48.