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

NEURAL MALADIES OF STUMPS. 361
The torture endured in some of these cases must be
extreme. The pain
is often unceasing, and is usually
referred to the lost limb, or, as the case progresses, to
the stump itself; while in some curious instances, as in
Nott's case, it is never felt or referred below this point.
The aching and shooting pains are finally complicated
by excessive hypersesthesia of the stump, with all the
mental and moral consequences which prolonged and
constant pain engenders. Opiates in excess become at
last the only comfort, and even these may fail to give
entire relief.
I have treated
several of the moderately severe forms
of this disease. All of them were removed by months or
years from the date of operation. In four, which were arm
cases, one below and three above the elbow, the nerves
were exquisitely tender and enlarged for some distance
above the stump. In another patient, they were tender
but not perceptibly larger. One case I failed to relieve,
and he declined an operation. Three others were successfully
treated by leeches at intervals, with hypodermic
injections of morphia and atropia, and large, warm poultices,
applied constantly. One proved obstinate, yet
was relieved, but not quite completely, by a short
mercurial course, mercurial ointment being used over the
arm-stump and axilla until slight salivation took place.
The gain was permanent, but was not so great as in the
other instances. I have seen no example of the terrible
forms of this disease which some authors describe,
and which require section of nerves or reamputation for
their relief. The history of such operations
is
by no
means encouraging, and too often one operation follows
another without permanent help to the patient. The
reason for these failures lies in the fact
that the disease
of the nerve passes gradually upward, and that an operation,
being unfortunately looked upon as a last resort, is
24