the little finger. The swelling usually affects the nerve for three or four inches above the elbow. When the nerve is exposed is found adherent to the neighbouring tissues and when the nerve sheath is incised the is found beneath the epineurium and between the nerve bundles. The abscess is sometimes localized to one place but at other times spreads up and down the nerve for a distance of two or three inches. Sometimes there may be two small an inch or two apart with a small sinus connecting the two. The abscess usually contains white cheesy semi- solid matter. When examined " microscopically, leucocytes, lymphocytes, and lepra" cells are found. A few lepra bacilli are " usually found, some in lepra" cells and some lying free. are short These usually forms, only about 2 or 3 }t long, and may be degenerated or dead. In six cases of abscess of the ulnar nerve a different condition was found. Here the nerve was not markedly thickened and in connection with the nerve, but slightly removed from it, there was found a swelling varying from the size of a to that of a pea pigeon's egg. This swelling was usually well defined and capsulated to and not adherent the skin, but in one or two cases the swelling was diffuse and had no definite margin and in one case the abscess was about to burst through the skin. At operation these swellings were found to be abscesses containing cheesy matter as already described, enclosed in a fibrous tissue capsule and having a narrow neck with a sinus passing through the sheath of the nerve to the interior of the nerve. This condition had apparently been brought about by the formation of an abscess inside the nerve sheath, the abscess bursting out- wards through the sheath forming an encapsulated the swelling outside nerve, instead of spreading nerve as up and down the in the other 8 cases. Hence less the marked swelling of the nerve itself. In the radial nerve.?In one case a similar nerve abscess in leprosy. abscess was found outside the nerve. In the internal cutaneous nerve of the forearm By JOHN LOWE, m.b., ch.B., nerve other forms of abscess were found in 3 Leper Hospital, Dichpali, Nizam's Govt. State Ry. cases. Here the abscesses have been small and in case every multiple. In one recent case Muir (1924) has recorded the occurrence of five different abscesses quite small and with no nerve abscess in leprosy. We have ap- investigated parent connections between them were this condition and our are as follows:? found at findings intervals of about two inches Incidence.?In about cases of of along the nerve 1,000 leprosy from elbow to wrist. This is we have found nerve abscesses in exceptional. The all kinds 19 two other cases have each shown two abscesses, patients. in one case connected a sinus Nerves commonest nerve to be by running inside affected.?The the sheath, in the other case ulnar 14 the next separate. Some of affected is the nerve, cases; were the abscesses confined inside nerve the internal cutaneous nerve of the the commonest, some had burst out into the 1 sheath, subcutaneous .forearm, 3 cases; the median nerve, case; the tissuei radial nerve, 1 case. We have never found a The median nerve.?In one case a double ab- nerve abscess except in the arm. scess was found situated just above the The of the abscess varies somewhat ac- elbow, both abscesses being inside the sheath and to the nerve affected:? joined cording by a sinus. In the ulnar nerve.?In 8 cases there was a Symptoms and signs of nerve abscess.?These of the nerve, sometimes marked. are an thickening very exaggeration of the previously existing In some cases the nerve was found as thick as signs of nerve leprosy. In many cases there is Jan., 1929.] MEL^ENA IN A NEWLY-BORN BABY: SEN GUPTA. 25

tender- of adrenalin subcutaneously and of 0.02 gram of nerve, extreme marked swelling of the and potassium antimony tartrate intravenously. increase in anaesthesia, ness, severe , are Dr. Muir has recently suggested to us the oral These symptoms " contraction of fingers. is administration of to control nerve where the abscess Ephedrin" most marked in those cases reactions. In to nerve reactions as the patients subject nerve sheath pressuie confined inside the the this may be at the same time as or is severe. When given shortly exerted by the abscess these after the iodide and the nerve reactions the nerve sheath potassium abscess bursts through is can thus be or rendered much less less as the pressure prevented symptoms are much severe. reduced. swell- a definite fluctuating Reference. Sometimes there is cases in those in but this is usually found only Muir (E.), 1924. Nerve abscess leprosy. Ind. ing nerve sheath. Med. Gas., Vol. 59, No. 2. where the abscess is outside the formation of Causes of nerve abscess.?The with to be associated the abscess o^ten appears A patient the of reaction. occurrence leprous forms on the and a swelling gets a nerve reaction sub- when the reaction nerve, which diminishes A few not disappear. sides but does entirely the swell- reaction occurs and weeks later another reactions an and with subsequent ing increases, that nerve abscess is formed. It is noticeable in those patients abscess has been more frequent iodide-antimony who are receiving potassium due to treatment for This is apparently leprosy. treatment. reaction caused by this leprous abscess is often It is also noticeable that nerve of the associated with the milder form and the patient's where the is slight In three cases resistance is high. comparatively to the one was confined the disease apparently were present ulnar nerve and the only symptoms In six those due to this nerve involvement. nerve symptoms cases there were more general from those but no bacilli were found apart lepra In the other ten found in the nerve abscess. of skin leprosy cases there were some slight signs nerve . but the lesions were predominating of nerve abscess, In our the formation experience with a in itself, is associated though troublesome and so high of resistance of the patient degree with to the is not an unfavourable sign regard disease. every case Treatment nerve abscess.?In of the nerve where nerve abscess is suspected, If an should and the sheath incised. be exposed out with abscess is found it should be scraped tissue. Drain- care to avoid damage to the nerve have found unneces- age after the we operation the abscess was sary in one case where except the skin. and about to burst through large is found or an abscess On operation, whether the be incised over not, the nerve sheath should nerve should be whole area of the thickening, in the ulnar freed from all pressure especially and the internal nerve the olecranon between in these of the humerus. Operation condyle be very severe, cases relieves , which may and often the development undoubtedly prevents lesions. of contraction of the fingers and trophic cases receiv- nerve abscess.?In . Prevention of care must iodide treatment, great ing potassium so that be exercised in the dosage only regulating If nerve reactions mild reactions are produced. by injections are severe they should be controlled