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

TREATMENT. 285
and neuralgia also; and altbougli, for reasons alread}'
is in all
stated, neither the return of sense nor of pain
cases conclusive as to the reunion of the nerve ends, it
were wise to take every precaution against this occurrence.
It is desirable also to make, at the time of operation, a
rapid microscopic examination of the portion of nerve
removed, because only the microscope is fully competent
to decide whether or not we have reached the
reo-ion of normal nerve tissue, and until this is done we
can possess no certaintj^ that the operation will prove successful.
On pages 288-291 will be found the statistics of these
operations, but a careful study of the individual case and
of the state of the nerve will ofler far better ground for
prognosis than any table of cases can ever furnish us.
Should the pain recur, it has been advised to amputate
the member, and this grave step has been frequently taken,
although I do not conceive that it can ever be justified
except where more than one nerve is involved, or where
grave injury has rendered the limb altogether useless.
"We are certainly able to make neural reunion impossible,
and, if so, I cannot see what advantage amputation
offers which resection higher up does not also afford.
Moreover, when resection has failed, this more extreme
step is not always successful, as the following curious case
will show :
Case 46.—A soldier had his leg crushed in a railway
accident, August 1, 1862. Amputation was done August
12th, at the junction of the lower and middle third.
stump was conical, the bone bare. In 1863, after a journey,
in which he was exposed to cold, he consulted Dr.
Nott for intense neuralgia of the stump, which, in September,
1863, Dr. Bayless amputated without relief. In
May, 1864, Dr. Nott removed the stump again, taking off