Neuralgia and the diseases that resemble itAnstie, Francis Edmund
Science
Neuralgia and the diseases that resemble it
Anstie, Francis Edmund
Neuralgia
The nervous supply to the skin of the anterior and external portion of
the thigh includes: (1) The middle cutaneous, (2) the internal
cutaneous, and (3) the long saphenous branch of the anterior crural
nerve; (4) the cutaneous branch of the obturator; and (5) the external
cutaneous nerve, derived from the loop formed between the second and
third lumbar nerve. The sensitive twigs derived from the two latter
sources, equally with the branches of the anterior crural, are liable to
be secondarily affected by neuralgia, which commences in the
lumbo-abdominal nerves; but it must be a rare event for them to be the
seat of a primary neuralgia. The only occasion on which I have seen
anything which looked like the latter was in the case of a porter, who,
in straining to lift a very heavy load, ruptured some part of the
attachment of the tensor vaginæ femoris. But the susceptibility of all
the nerves of the front of the thigh to secondary or reflex neuralgia
receives numerous illustrations. The extremely severe pain at the
internal aspect of the knee-joint, which is such a common symptom in
morbus coxæ, is evidently a reflex neuralgia of the long saphenous
nerve, the ultimate irritation being situated in the branches of the
obturator nerve which supply the hip-joints. For some reason
unexplained, it happens that this saphenous nerve is specially liable to
be affected in a reflex manner: for instance, this happens in a
considerable number of cases of sciatica. I have a lady now under my
observation, in whom the secondary neuralgia of the saphenous nerve has
become even more intolerable than the pain in the sciatic, which was the
nerve primarily affected. The pain in these cases very frequently runs
down the inner and anterior surface of the leg to the internal ankle.
Sometimes the branches of the anterior crural become the seat of
intensely painful points in the course of a long-persisting sciatica. A
patient at present under my care has a spot, about the size of a
shilling, just at the emergence of the middle cutaneous branch from the
fascia lata, which is intensely and persistently tender to the touch,
and the skin here is so exquisitely sensitive to the continuous galvanic
current that the application of moistened sponge-conductors, with a
current of only fifteen Daniell's cells, causes intolerable burning
pain; whereas at every other part of the limb the current from
twenty-five cells can be borne without much inconvenience.
(_g_) _Femoro-popliteal Neuralgia, or Sciatica._--This is one of the
most numerous and important groups of neuralgia; but, notwithstanding
that there are plenty of opportunities for studying it, I venture to
think it is very commonly mistaken for different and non-neuralgic
diseases, and they for it. The rules of diagnosis which will be laid
down for all the neuralgiæ would nevertheless prevent these errors, if
carefully attended to.
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