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Still, looking at the poor old fellow's rags, and remembering that it is new year and the time for a change of raiment, one cannot help thinking, "Old fellow, you evidently come in for more resect, after all, than material assistance, and would, no doubt, willingly exchange a good deal of the former for a little of the latter."
When this is difficult, a portion may be resected from each of the nerve-trunks at a higher level; and if this fails to give relief, a fresh amputation may be performed. When there is agonising pain dependent upon an ascending neuritis, it may be necessary to resect the corresponding posterior nerve roots within the vertebral canal.
Failure to resect may have been due to the great amount of work pressing upon the surgeons. They were worked as many hours continuously as they could stand, and still many a man had to be neglected. I was taken off the table and put back on my stretcher, which was set down in a wall tent, this tent was as full as it well could be of amputated cases.
Ganglia in the substance of tendons are rare. The diagnosis rests on the observation that the small tumour is cystic, and that it follows the movements of the tendon. The cyst is at first multiple, but the partitions disappear, and the spaces are thrown into one. The tendon is so weakened that it readily ruptures. The best treatment is to resect the affected segment of tendon.
Finally the periosteum gives way, and an abscess forms in the soft parts; and if left to itself ruptures externally, leaving a sinus. The most satisfactory treatment is to resect sub-periosteally the diseased portion of the diaphysis. The situation and extent of the disease are shown in X-ray photographs.
It is usually sufficient to incise the periosteum, but when the disease occurs in a rib it may be necessary to resect a portion of bone.
In the case of the first dorsal nerve, it may be necessary temporarily to resect the clavicle. The usual after-treatment must be persisted in until recovery ensues, and care must be taken that the paralysed muscles do not become over-stretched.
When the nerves in a stump have not been cut sufficiently short, they may become involved in the cicatrix, and it may be necessary, on account of pain, to free them from their adhesions, and to resect enough of the terminal portions to prevent them again becoming adherent.
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