(138) Internal popliteal.—Wounded at Paardeberg. 400-500 yards. Entry, about the centre of the outer half of the patella; exit, at the centre of the calf, about 2 inches from the popliteal crease. Five days after the injury severe burning pain developed in the sole. A fortnight later the pain was much less severe, but varied in degree with the heat of the weather, being worse when cool. At this date, however, rubbing became comforting.
(139) External popliteal.—-Wounded at Magersfontein. Entry, 1 inch above the upper end of the internal margin of the patella; exit, at the margin of leg, just below the outer tuberosity of the tibia. Complete peroneal paralysis followed the injury. A month later the nerve was bared and found slightly thickened. An improvement in cutaneous sensation followed quickly, and a much slower improvement in the motor power commenced.
(140) External popliteal nerve.—Wounded at Beacon Hill. A bayonet entered over upper quarter of fibula, and passed between the bones of leg into the calf. An aneurismal varix of the calf vessels developed, also incomplete peroneal paralysis. The scar was raised from the nerve (Major Simpson, R.A.M.C.) six weeks later, and at the end of a fortnight the power and sensation were both much improved and the patient returned to England.
(141) External popliteal.—Wounded at Modder River. Entry, 1/2 an inch above the internal border of the patella; exit, 1½ inch from the head of the fibula and over that bone. The wound was followed by peroneal paralysis. Six weeks later sensation was still diminished in the anterior tibial and musculo-cutaneous nerve areas, and marked foot-drop, little improved, persisted. The patient came to England, and at the end of twelve months is reported as very little improved.
(142) Anterior tibial.—Entry, 1 inch in front and below the external malleolus; exit, at the centre of the sole, just anterior to the bases of the metatarsal bones. Wasting and paralysis of extensor brevis digitorum.
(143) Small sciatic and small saphenous.—Wounded at Magersfontein. 200 yards. Two wounds: (i) Entry, below the centre of the twelfth rib on the left side; exit, immediately to the left of the buttock furrow at upper part, (ii) Entry, in the right loin, midway between the last rib and iliac crest; exit, just within the centre of the left buttock; the two wounds crossed diagonally. Hyperæsthesia in area of distribution of small saphenous and small sciatic nerves, which rapidly improved.
(144) Lumbar plexus.—Boer, wounded at Magersfontein. Entry, eleventh interspace, posterior axillary line; exit, tenth interspace, right mid-axillary line. Impaired sensation in area of distribution of external cutaneous and crural branch of genito-crural nerves. At the end of a fortnight anæsthesia was less apparent, but a feeling of numbness persisted, which soon disappeared.
Prognosis and treatment.—In considering the prognosis in cases of nerve injury, several of the points already raised as to the nature of the lesion are of importance. Short of actual section, it may be broadly stated that no lesion is too serious to render ultimate recovery impossible.
In cases in which the injury has been produced by a bullet fired at a short range, or in which contact with the nerve has been close, the return of functional activity is very slow. In such instances the condition probably resembles that in which a divided nerve has been sutured, with the additional disadvantage that a considerable portion of the nerve, both above and below the point actually struck, has been destroyed as far as the conduction of nervous impulses is concerned. This may reasonably be concluded in the light of the evidence offered by the injuries of the spinal cord, in which several segments usually suffered if the velocity of the bullet was great, and also if the fact is remembered that, when thickening takes place, a considerable length of the nerve is usually implicated.
Recovery is notably slow in the case of certain nerves, e.g. musculo-spiral and peroneal, even when the injury has not been of extreme severity. Again, these same nerves are apparently more seriously affected by moderate degrees of damage than are others.