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

286 INJURIES OF NERVES.
an inch of bone. Portions of two large nerves were found
enlarged and engorged. The pain continued, and was
intolerable.
June 1st.— Dr. Nott opened the popliteal space aiid
took out an inch of the trunk of the sciatic, and apparently
about three inches of the popliteal and peroneal
nerves, all of which were enlarged, a^o relief followed,
and in May, 1865, Dr. Nott, evidently thinking there
might have been reunion, and, as he justly says, with
"no very good physiological reason for so doing, dissected
out the two large nerve trunks completely down to
the extremity of the stump.''" He does not say whether
or not there had been reunion. Naturallv, no relief
ensued, and, in despair, the thigh was removed four inches
above the knee, when the sciatic nerve was seen to he
eno-oro-ed and double its normal size. The neural o;ia
continued, and in August, 1865, Dr. i^ott exsected tlie
sciatic nerve at its point of pelvic exit, removing an inch
and a quarter. The upper half only of this portion seemed
healthy, but whether it was studied with the microscope
or not we are nowhere informed. Some relief was thus
obtained, but the next day the pain returned, and then,
as always, was referred to the end of the existing stump,
and not to the lost limb,— a rare anomaly.
Dr. Nott believes that his patient was really much eased
by this final procedure, but that his craving for opium
caused him to malinger.
As an illustration of the tendency of neuritis to passcentrally,
of its sclerotic results, and of the need for early
resection higher up the nerve, this case is most instructive.
I have stated in the accompanying table the more important
particulars of twenty-three cases of exsection of
portions of nerves for traumatic neuralgia, with one of
simple division.
These include a variety of nerves, in five of which the