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

CHAPTER XII.
TREATMEN T— C ONTINUED.
Neurotoywj. — When every otlier means of relieving pain
lias been exhausted, the very grave question of the propriety
of nerve section arises. As regards the simpler cases
of lancet wounds and the like, requiring division of superficial
filaments, nothing more need be added but when
;
the nerve to be divided is a great trunk, more serious
considerations present themselves. In deciding for an
operation, we are, of course, influenced by the extent and
duration of the pain and by the fact that cases of common,
aching, traumatic neuralgia depend very often on morbid
nerve states, which, unless checked, gradually but surely
extend up the nerve, and may thus get beyond the reach,
of the knife, and so make permanent the tortures they
oecasiou. On the other hand, causalgia, in my experi^
ence, gets well in time ;
nor should we forget that in
severing a great nerve we are probably condemning certain
parts to perpetual functional idleness ; yet the earlier
the operation the lower down it
may be done, and the less
will be, therefore, the loss of motion and sensation.
When, after due regard to these points, an operation
is decided upon,
it becomes requisite to determine at
what point
it shall be done. To settle this, the limb
concerned should be inspected with extreme accuracy, to
learn what regions of skin or tissue seem to be painful,
because it is essential to cut the nerve above all the painjaelding
branches.
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