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

TREATMENT. 287
exsected portion
is described as variously altered, reddened,
indurated, or thickened, no statement being made
as to the pathological condition of the remainder.
In two only was there no immediate relief from the
operation. In four the relief was partial, or came gradually,
and in the rest it was entire and immediate.
The future of these latter cases was less happy, since
in five the pain returned at remote periods. As a final
result, we learn that in sixteen the excisions eft'ected
lasting ease for the patient, although
in several the announcement
as to the cure has been made too early ta
leave us sure of its
permanency.
In one case six excisions were practiced before relief
came, and there was a relapse in eighteen months.
Dr. Morton's case was an interesting example of causalgia.
Five inches of the radial nerve were removed,
without any good eflect, and relief was gained by amputation.
In jSTausick's case, excision also failed, and amputation
succeeded. In the former example
it is clear
that the patient's statements as to the seat of pain led ta
a diagnostic error with regard to the nerve involved.
is difiicult to see why, in these cases, amputation should
be allowed to replace neurotomy.
If the statements as to loss of function and its return
are to be trusted, they show how rapid, in some cases,
is the recovery of function, and how incomplete
is its loss
in others. The general conclusion is favorable to neural
resection as a means of relief in extreme cases of traumatic
neuralgia. I am quite confident that if the operation
were not delayed so long the percentage of recoveries
would be greater. I am equally certain, that were it
always done in accordance with the very obvious rules
which I have here laid down, it would be far more often
successful.
It