ss of callus, an aneurysm, or by any similar gross lesion.
We shall only consider here those forms of neuralgia which are amenable
to surgical treatment.

#Brachial Neuralgia.#--The pain is definitely located in the
distribution of one of the branches or nerve roots, is often
intermittent, and is usually associated with tingling and disturbance of
tactile sensation. The root of the neck should be examined to exclude
pressure as the cause of the pain by a cervical rib, a tumour, or an
aneurysm. When medical treatment fails, the nerve-trunks may be injected
with saline solution or recourse may be had to operative measures, the
affected cords being exposed and stretched through an incision in the
posterior triangle of the neck. If this fails to give relief, the more
serious operation of resecting the posterior roots of the affected
nerves within the vertebral canal may be considered.

_Neuralgia of the sciatic nerve_--#sciatica#--is the most common form of
neuralgia met with in surgical practice.

It is chiefly met with in adults of gouty or rheumatic tendencies who
suffer from indigestion, constipation, and oxaluria--in fact, the same
type of patients who are liable to lumbago, and the two affections are
frequently associated. In hospital practice it is commonly met with in
coal-miners and others who assume a squatting position at work. The
onset of the pain may follow over-exertion and exposure to cold and wet,
especially in those who do not take regular exercise. Any error of diet
or indulgence in beer or wine may contribute to its development.

The essential symptom is paroxysmal or continuous pain along the course
of the nerve in the buttock, thigh, or leg. It may be comparatively
slight, or it may be so severe as to prevent sleep. It is aggravated by
movement, so that the patient walks lame or is obliged to lie up. It is
aggravated also by any movement which tends to put the nerve on the
stretch, as in bending down to put on the shoes, such movements also
causing tingling down the nerve, and sometimes numbness in the foot.
This may be demonstrated by flexing the thigh on the abdomen, the knee
being kept extended; there is no pain if the same manoeuvre is repeated
with the knee flexed. The nerve is sensitive to pressure, the most
tender points being its emergence from the greater sciatic foramen, the
hollow between the trochanter and the ischial tuberosity, and where the
common peroneal nerve winds round the neck o