preferable to sacrifice the limb by having recourse to amputation, than to attempt to save the patient's life by a simple division of the injured nerve.

When a nerve is injured in any part of the body, where amputation is inadmissible, the complete division of the nerve becomes the only mode of treatment which can be had recourse to. It is not a very unusual circumstance for a wound of the frontal branch of the fifth pair of nerves to be followed by amaurosis, and the complete division of the nerve beyond the injured part, has restored vision. A similar operation on other injured nerves, may therefore be expected to produce equally beneficial effects.

AN ACCOUNT

OF SOME

REMARKABLE SYMPTOMS

WHICH WERE CONNECTED WITH A PAINFUL AFFECTION

OF THE

EXTREMITY OF THE LEFT THUMB,

TOGETHER WITH THE

MODE OF TREATMENT.

BY JOHN PEARSON, Esq. F.R.S. F.L.S. M.R.I.

SENIOR SURGEON OF THE LOCK HOSPITAL, &c. &c.

Read April 1, 1817.

LADY , aged eighteen years, was attacked suddenly by an acute pain on the inner part of the left thumb, near to its extremity, on the 14th of November, 1814. The pain extended gradually to the first articulation; but it was unattended by redness, tumefaction, or any other visible character of disease. The lady supposing that this acute pain indicated the commencement of a whitlow, immersed her thumb in hot water, several times in the day; and deriving no relief from this, she applied a poultice of bread and milk, which seemed

CASE OF A PAINFUL NERVOUS AFFECTION. 253

rather to aggravate her sufferings. After the lapse of about fourteen days, she consulted a surgeon, who directed two leeches to be applied on the af fected part, and the poultice to be continued.

On the following day the thumb became inflamed and swollen as far as the second joint, and had acquired so high a degree of sensibility, that Lady

experienced a most severe pain from the slightest touch, and the muscles of the part were no longer capable of voluntary motion. The forefinger of the same hand soon became disordered by a similar affection, was morbidly sensible in a high degree, and its muscular powers were equally obstructed. The three remaining fingers of the left hand were gradually subjected to the agency of this disease; they participated slightly in the morbid sensibility of the thumb and fore-finger, but their flexor muscles became so much contracted, that the nails of the fingers were pressed forcibly against the palm of the hand; they were no longer under the control of the will, and every attempt made to extend them, was attended with insupportable pain.

This disease proceeded by degrees, from the thumb and fore-finger, to the fore-arm; the skin and muscles became painfully sensible, the joint of the elbow was contracted, and in a short period of time, very little power of voluntary motion remained in the brachial muscles, from the shoulder

to

down to the hand. Lady was now obliged suspend her arm in a sling; the sensibility of the whole limb had become inexpressibly distressing; the bulk of the arm likewise diminished gradually, so that in the space of about three months, it was reduced not less than one inch in its circumference, between the elbow and the wrist. The right arm became, by insensible degrees, involved in this extraordinary morbid affection; it acquired a painful sensibility, and a considerable diminution of its muscular powers. Lady was not indeed

obliged to support it with a sling, but the debility was such, as to render her unable to use a pen, and had she been capable of this effort, the pressure necessary for the sustaining and employing of so light a substance, would have excited an insupportable access of pain. The right arm never exhibited any discolouration, intumescence, nor indication of atrophy; it admitted also of such motions as did not expose any part of its surface to external pressure; she likewise enjoyed occasional intervals of relief from suffering, extending from twenty-four to forty-eight hours, yet, even during these periods of comparative ease, she was quite disabled from raising a small weight, or using any exertion that required the compressing of a solid body.

In the course of a few weeks from the commencement of this disease, her ladyship began to complain of pain and debility in the lower extre

mities: this morbid condition of these parts allowed of frequent intermissions; but whenever she was suffering from an omission of pain, she was rendered incapable of walking. During the intervals of these attacks, she experienced a great weakness of the lower extremities, and nearly an inability of locomotion, being incapacitated from using exercise for more than a few minutes, at any one time.

From an early period after the attack of this disease, and while it was making an alarming progress, her ladyship was attended by very respectable professional gentlemen, who resided in her own neighbourhood; she occasionally derived a temporary benefit from their assistance, but the more prominent symptoms of her complaint were not subdued.

was re

Early in the Spring of 1815, Lady moved to Edinburgh, and had the advantage of consulting some of the most eminent physicians and surgeons in that city. Various tonic and antispasmodic medicines were prescribed, and different topical applications were employed; but no considerable relief was derived from any of them. She was then advised to take mercury in small doses, with a decoction of sarsaparilla, and from these remedies she seemed to obtain some benefit; but her appetite becoming quickly impaired, and her strength visibly decreasing, she soon abandon