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

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TREATMENT. 267
history of wound or blow, and that of inflammation,
subsiding to a subacute stage, or never rising to
an acute grade, we fall within a larger class of cases.
The pain which comes from such pathological states is
very varied in type; but so long
as the nerve was tender
it was our custom, in the U. S. A. Hospital, to resort to
repeated leeching, which proved the most potent remedy.
Since the war, I have frequently used dry cold, in any
case of violent pain with steady local tenderness of the
nerve.
Employed for a week or two, it is sure to be of service,
and, under its use, the nerves lose their irritability
and distinctly shrink in size; but, to make this method
most available, it must be kept up unfailingly both day and
night. The certainty with which dry cold will break up
the tendency of these cases to intermit, is most remarkable.
I have under my charge at present a manufacturer
of plumbers' materials, who has for three years suffered
intensely from neuritis of the left sciatic nerve, with constant
increase of the pain at two o'clock every morning.
The speed with which this habit broke up, and the neural
tenderness lessened under the use of ice, was most satisfactory.
When dry cold cannot be applied, I resort to moist
heat, in the form of poultices, in which the whole limb
should be wrapped, the heat of these applications being sustained
by the aid of salt- or sand-bags, placed on their
outside.
A variety of local remedies have found more or less
favor in the treatment of traumatic neuralgia, whether
related plainly or not to inflammatory causes. They
passed successively under trial in our vast experience
during the war. For the most part they may be classed
with the therapeutics of despair, the use of narcotic injections
having allowed us to dispense with them altogether.
Counter-irritation.— The use of irritants over the cicatrix
or the nerve track we found but rarely of value, and they