A text-book on nervous diseases by American authors / edited by Francis X. Dercum.

  • Dercum, Francis X. (Francis Xavier), 1856-1931.
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: A text-book on nervous diseases by American authors / edited by Francis X. Dercum. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    fibres of the soleus muscle arising from the tibia are divided. A second layer of the deep fascia is then disclosed, covering in the tibialis posticus muscle. The posterior tibial nerve lies underneath this fascia to the fibular side of the posterior tibial artery. The fascia is divided, the artery found, and by it as a guide the posterior tibial nerve. MuscuLO-cuTANEOUS Neeve. The musculo-cutaneous nerve is a branch of the external popliteal, which pierces the deep fascia from one-half to two- thirds of the way down from the knee to the ankle. An incision obliquely to its course discloses the nerve in the superficial fascia. Internal Saphenous Nerve. The internal saphenous nerve pierces the deep fascia to the inside of the knee in the interval between the tendons of the sartorius and gracillis, and then descends along the inner side of the leg just behind the internal border of the tibia. A slightly oblique in- cision at any part of its course below the knee will disclose the nerve in the superficial fascia. External Saphenous J^eeve. This is a branch from the internal pop- liteal nerve, and pierces the deep fascia at the upj^er part of the calf. It then descends toward the outer side of the ankle-joint. An incision some- what oblique to its course will reveal it in the superficial fascia. PuDic Nerve. The pudic nerve accompanies the pudic vessels upward and forward along the outer wall of the ischio-rectal fossa, and under the protection of the tuberosity and ramus of the ischium. It lies between the two layers of the obturator fascia. An incision in the perineum just to the inner border of the tuberosity of the ischium, and a blunt dissection toward the obturator fascia, with division of its outer layer, will disclose the vessels and nerve which lie about one and a quarter inches above the lower border of the tuberosity. The Digital Nerves. The digital nerves of the fingers and toes run in a line corresponding to the junction of the palmar and lateral aspects upon each side of the fingers. Those to the thumb emerge from the palm at the border of the thenar eminence near the base of the first phalanx. All of them can be reached best by a lateral flap. SURGICAL TREATMENT OP CONTRACTURES. Most of these cases heretofore have been left untreated surgically, under the mistaken notion that no good could be done. But of late the surgeon has interfered, to the great advantage and often to the entire cure of the patient. In cases in which the joints have become immobilized from rheumatic, gouty, or other forms of arthritis, if the case is seen early enough, the adhe- sions should be broken up under ether, repeatedly, if necessary, care being taken, of course, not to apply such a degree of force as will either be fol- lowed by serious inflammation of the joint, or fracture of the bone. Sub- sequent massage, Swedish movements, hot and cold douches, and elec- tricity will often accomplish a great deal. If seen late, when firm anchylosis is established, it is doubtful whether in many cases any permanent good will result from such treatment, and I have seen very serious results follow, even to the point of imperilling life. It is, however, in the muscular contractures proper following nervous lesions that I have been able to accomplish very much of late. Tenotomy with forced flexion and extension and persistent suitable after-ti'eatment will sometimes restore even almost apparently helpless limbs to normal or nearly normal use. In contractures after cerebral lesions, attended with