Literary Notices. Ixxxi 



tion he mentions intense pain following the course of the sciatic, hy- 

 peresthesia in the lower part of the leg and foot, without there being 

 any sensitive perversion or trophic disorder. 



The condition of the patient allowed no hope of benefit from in- 

 ternal remedies, since morphine alone had produced transient relief; 

 and as his sufferings were very acute, there was performed on Nov. 

 II, the stretching of the sciatic with the purpose of affording relief. 

 Between the major trocanter and the ischium there was made an incis- 

 ion of 1 2 centimetres, parallel to the axis of the thigh, which allowed 

 easy access to the nerve, its isolation and its stretching. For this pur- 

 pose Dr. San Cristobal employed the index finger and thumb, with 

 which he exerted traction in the direction of its two extremeties. The 

 operation concluded with the application of sutures and a Lister band- 

 age. Scarcely had the effect of the chloroform ended, when the pa- 

 tient told us that the acute pain had disappeared and he refused mor- 

 phine ; but the hyperesthesia persists without troubling the padent. 

 This condition persisted. 



The following are the author's conclusions : 



1. Nerve stretching is indicated in mixed neuritis which does not 

 yield to therapeutic agents. 



2. The operation is simply, requiring no special instruments. 

 If the surgical method is used the wound should heal by first inten- 

 tion. 



3. The non-surgical method should be preferred where practic- 

 able. 



4. Complete cure cannot always be expected ; many cases 

 evince only slight amelioration, while in others, rupture or confirmed 

 neuralgia may be produced. 



5. Complications which are rare if the cord is healthy are rela- 

 tively frequent and serious if myelitis is present. 



6. The specific action of nerve stretching must be explained by 

 the effect of the operation upon the nerve centres. 



The Objeetire Symptoms of Neurasthenia.^ 



In spite of the current opinion that neurasthenia or nervous ex- 

 haustion has no symptomatic complex peculiar to itself, the author 



1 LoWENFlELD, L. Die objectiven Zeichen der Neurasthenic. Milnchener 

 vied. Abhandl. VI, 3, 1892. J. Lehmann. Price, i mark. 



