inishes the tendency to recurrence; a portion of the
nerve-trunk being sacrificed, means must be taken to bridge the gap. In
inoperable cases it may be possible to relieve pain by excising a
portion of the nerve above the tumour, or, when this is impracticable,
by resecting the posterior nerve roots and their ganglia within the
vertebral canal.

The so-called _amputation neuroma_ has already been referred to (p. 344).

_Diffuse or Generalised Neuro-Fibromatosis--Recklinghausen's
Disease._--These terms are now used to include what were formerly known
as "multiple neuromata," as well as certain other overgrowths related to
nerves. The essential lesion is an overgrowth of the endoneural
connective tissue throughout the nerves of both the cerebro-spinal and
sympathetic systems. The nerves are diffusely and unequally thickened,
so that small twigs may become enlarged to the size of the median, while
at irregular intervals along their course the connective-tissue
overgrowth is exaggerated so as to form tumour-like swellings similar to
the trunk-neuroma already described. The tumours, which vary greatly in
size and number--as many as a thousand have been counted in one
case--are enclosed in a capsule derived from the perineurium. The
fibromatosis may also affect the cranial nerves, the ganglia on the
posterior nerve roots, the nerves within the vertebral canal, and the
sympathetic nerves and ganglia, as well as the continuations of the
motor nerves within the muscles. The nerve fibres, although mechanically
displaced and dissociated by the overgrown endoneurium, undergo no
structural change except when compressed in passing through a bony
canal.

The disease probably originates before birth, although it may not make
its appearance till adolescence or even till adult life. It is sometimes
met with in several members of one family. It is recognised clinically
by the presence of multiple tumours in the course of the nerves, and
sometimes by palpable enlargement of the superficial nerve-trunks
(Fig. 86). The tumours resemble the solitary trunk-neuroma, are usually
quite insensitive, and many of them are unknown to the patient. As a
result of injury or other exciting cause, however, one or other tumour
may increase in size and become extremely sensitive; the pain is then
agonising; it is increased by handling, and interferes with sleep. In
these conditions, a malignant transformation of the fibroma into sarcoma
is to be suspecte