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

362 INJURIES OF NERVES.
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put off until by degrees the whole nerve trunk is so completely
involved that there remains no healthy portion of
nerve in which to perform neurotomy; while to leave any
of the sclerotic nerve above the line of section is only to
make probable future suffering.
Whatever hesitation as to nerve section may be reasonable
in other cases, there should be but little as regards
stumps: iirst, because delay is apt to make useless any
operation and
; secondly, because division of nerves in
stumps is productive of so little loss of valuable function.
When, then, the pain
is intense and lasting, and does not
readily yield, and the nerve trunks are tender, I should
strongly advise an early resection of the nerve as high
up the limb as possible.
The operation should be such as to provide against reunion,
by means already described ;* and if on microscopic
examination of the exsected portion of nerve it
prove to
be diseased, it would be advisable at once to divide it
still
higher ;
or if this be impossible, the central part
of the nerve should be actively treated by leeching, by
counter-irritants, and, perhaps, by cold.
Large numbers of operations for the relief of stump
neuralgia have failed because of attempts to remove only
the button-like enlargements at the ends of the nerves,
under the impression, not always erroneous, that in these
growths lies the cause of mischief. I fancy these, however,
to be but rarely the cause of trouble, and the
opinion is mischievous, because it postpones a more
radical operation.
Dr. is'ott's case, which I have elsewhere related, f is a
good example of progressive neuritis extending toward
the centres, consequent neuralgia, and mischievous delay
* See Neurotomy, p. 282.
f See p. 240, Treatment.