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

120 INJURIES OF NERVES.
the lumbar nerves, is earlj and disastrously evident in
the way of pain and other disturbing phenomena.
These remarks apply generally to this subject, and to
give examples throughout the bodj" would be only to anticipate
what I may have to say as to alterations of particular
nerves. As a rule, iibroid and other formations
of this nature, as well as aneurisms and syphilitic growths,
give examples in their relations to nerves of simple pressure
or elongation, but cancers may very early affect the
nerve tissue, and occasion results which are due to other
than merely physical causes.
I have seen instances of this in cases of carcinoma
involving the lumbar plexus, in masses of a size too small
to account by pressure alone for the agonizing pain in the
lower limbs.
In two such cases I found the nerve trunks enlarged
and reddened; so that here, as elsewhere, inflammatory
conditions determine an early manifestation of pain ih
stretched or compressed nerves.*
The following ver}^ interesting history is a good example
of the difficulties which sometimes surround the
earlier stao:es of these cases :
Cuse 13.— In April, 1871, J. II., a porter, aged sixty-six
years, presented himself at my clinic for nervous diseases.
Three vears before he had
He was thin, sallow, and feeble.
strained his back while carrying a trunk. The pain in
the coccygeal region, with a sense of something having
given away, was intense at the time, but slowly lessened,
never, however, being wholl}^ absent. Two years ago he
began to have difficulty in urinating, with numbness in
the left leg,
and pain in the track of the sciatic nerve. At
times the leg was weak ; usually it was as strong as the
other limb. When the pain in the leg was most severe,
* Romberg, vol. i. p. 10, Sydenham Society's Translation.