re is good prospect of freeing
the nerve from compressing adhesions. The two strongest indications for
operation are (1) signs pointing to the secondary implication of the
nerve in a cicatrix, especially when these are of such a nature as to
indicate local tension, fixation, or pressure; (2) the possibility of
the irritation being the result of the presence of some foreign body,
such as a bone spicule, or portions of a bullet mantle; in such cases
the X rays will often give useful help.

With regard to the early exploration of cases of traumatic neuralgia, it
may be pointed out that when this was undertaken the results were as a
rule very temporary. In many cases in which the measure was resorted to,
either no macroscopic evidence of injury to the nerve was discovered, or
a bulbous thickening was met with of such extent as to make excision
inadvisable, even if it were considered otherwise the most suitable
treatment.

Even when complete section of the nerve was assured by the absence of
any power of reaction to stimulation by electricity from above on the
part of the muscles, operation was better not undertaken until
cicatrisation had reached a certain stage. If done earlier than at the
end of three weeks, the sutured spot became implicated in a hard
cicatrix, and any advantage to be obtained by early interference was
lost. When partial division of a trunk was determined, the same date was
the most favourable one for exploration, the gap in the nerve being
freshened and closed by suture. There is little doubt, however, that in
some cases such injuries were recovered from spontaneously.

In view of the uniformly bad results observed in the case of the seventh
nerve, I am inclined to think that the above rules might be tentatively
relaxed, and the nerve primarily explored by an operation resembling
that for mastoid suppuration. It is of course doubtful whether the
trouble does not generally result from the vibratory concussion alone;
but as this is not certain, and the operation would only have to be
performed on patients already permanently deaf, it might be worth while
at any rate opening the Fallopian canal with the object of relieving
tension. It is not probable that in any of the cases quoted much
splintering of the bone had occurred, as the wounds appeared to be of
the nature of pure perforations.

CHAPTER X

INJURIES TO THE CHEST

In regard to Prognosis wounds of the chest furnished the most hopeful