REPRINTED FROM THE "CANADA MEDICAL & SURGICAL JOURNAL," 
NOVEMBER, 1SS2. 
AN ACCOUNT OF THREE CASES OF SCIATICA AND 
ONE OF PAINFUL STUMP TREATED BY 
NERVE-STRETCHING. 
By JAS. STEWART. M.D., L.R.C.P. & S., Edin. 
{Read befoie the Canada Medical Association, at Toronto, September, 1882.) 
J. 8., joiner, aged 38, when first seen in February, 1881, 
complained of having suffered severely from a pain in the course 
of the left sciatic nerve for four years. For a period of six 
months prior to coming under observation, he suffered so much, 
especially when standing, that he was unable to do any work. 
He has a markedly neurotic family history. He has been much 
exposed, and it is to " cold " contracted in roofing buildings that 
he attributes his present troubles. He complains of great ten- 
derness when pressure is made over the course of the sciatic in 
the upper part of the thigh. He has been treated by the hypo- 
dermic injection of morphia, by blisters, by the internal use of 
turpentine, etc. None of the above means having any perma- 
nent influence over the severity of the pain, it was decided to 
stretch the nerve. This operation was performed on the 19th 
of January, 1881, with antiseptic precautions. On removing 
the dressings eight days afterwards, the wound was found united 
throughout. The result in this case has been very satisfactory. 
The pain which formerly troubled with such severity that he was 
unable to work, seldom afflicts him now, and then only in a mild 
degree. He is able to attend his work without any inconvenience. 2 
The second case was in a man aged 58, labourer, who, for 
over a year previous to coming under observation, was unable 
to work on account of a severe pain in the course of the left 
sciatic and anterior crural. It is five years since the pain first 
troubled him, and it has been steadily increasing in severity in 
spite of the use of various remedies. On the 4th of October 
last his left sciatic was stretched, with antiseptic precautions. 
The wound was found united on the tenth day after the opera- 
tion. The result in this case is not so satisfactory as in the 
previous one. He still suffers, but nothing in comparison to his 
former trials. He is quite able to work. 
The third case was that of a man aged 23, who, for two years, 
has been afflicted with a most severe and rebellious form of 
sciatica. The employment of the usual remedies recommended 
in these cases had little or no effect in even mitigating the 
severity of the paroxysms. The left sciatic was stretched on 
the 28th of March last. The operation was one of much more 
than usual difficulty, on account of the nerve dividing after its 
exit from the pelvis, and the close adhesion which one of the 
branches (the anterior one) had formed to the surrounding 
tissues. Both branches were stretched. The wound healed in 
two weeks. It is now nearly six months since the operation was 
performed in this case, and as he has remained free from pain 
during all this time, he may be considered cured. 
The fourth case is where stretching was resorted to for the 
relief of a painful stump. The patient, a man 70 years of age, 
had his left leg amputated three inches below the knee-joint five 
years ago. He says he has never been free from pain in the stump 
since that time. He is often unable to sleep at night on account 
of its severity. Two weeks ago his left sciatic, which was of an 
unusual size, was stretched. For a few days following the 
operation he experienced no relief, but during the last week the 
pains have almost ceased. It remains to be seen whether the 
relief will be permanent or not. 
It is to the great kindness of my friends Drs. Mackid of 
Lucknow and Gun of Durham that I had the privilege of seeing 
and operating on the third and fourth cases. 3 
Nerve-stretching is now a well-recognized and very successful 
means of treating obstinate cases of neuralgia. Dr. Chandler 
of New Jersey has collected seventy cases of rebellious sciaticas 
treated in this way ; 97 per- cent, of these cases were either 
cured or relieved. It is an operation that is not altogether 
devoid of danger. There are, at least, five fatal cases reported. 
In three of these, chloroform appears to have been the cause of 
the fatal issue. In one case I was fortunate enough to be able 
to take a tracing of the pulse while the nerve was being stretched. 
The immediate effect of the stretching was a reduction in the 
pulse rate from 80 to 40. This occurred within ten seconds. 
At the same time there was a slight fall in the blood-pressure, 
which was previously low, from the chloroform. It is well-known 
that the violent irritation of a sensory nerve can bring about 
stand-still of the heart. As chloroform has somewhat a similar 
action on the heart, it is not at all wonderful that when these 
two powerful factors are in operation that a fatal result has 
occurred. As ether has directly opposite action to chloroform 
on the heart, it should always be used in these operations. In 
two of the reported cases ether was used, and the difference in 
its cardiac action from chloroform was strikingly illustrated. 
The utmost pressure exerted in pulling the nerve while the 
patients were under ether could not reduce the pulse more than 
four beats in the minute, and even this trifling reduction was 
some ten seconds in being brought about. With chloroform, on 
the other hand, a reduction of 40 beats per minute was effected 
almost instantly. Further, ether does not reduce the blood- 
pressure, and in this lies its great safety.