Prevention of Formation of End-Bulb Neuromata.

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Abstract
End-bulb neuromata are of importance as a possible causative factor in the phenomenon of the phantom limb and painful amputation stumps. This study was made to develop procedures for inhibiting the formation of these neuromata. The importance of the pressure of growth, or the tendency for regeneration of peripheral nerves, is discussed with the conclusion that this growth pressure must be overcome if the normal phenomenon of unlimited growth with the formation of end-bulb neuromata is to be prevented. The end of the severed peripheral nerve was enclosed in rigid tubes of various materials. If the tube fits snugly over the nerve, the nerve fibers fail to proliferate but the encased nerve does not die. If, on the other hand, the end of the nerve is placed in a loosely fitted, rigid tube, growth proceeds until the tube is filled with nerve fibers. Then, again, growth ceases without subsequent degenerative changes. A similar result was obtained when the stump of the peripheral nerve was injected with 10% tanic acid or 2% gential violet solution. These substances caused the laying down of fibrous tissue around the individual nerve fibers so that the severed end of the nerve is placed in an essentially rigid encasement. In addition, there is probably a chemical inhibition to growth. Following amputation, the peripheral nerve stumps in 15 patients were injected with 2% gential violet. No contra-indications to this procedure have been observed. No conclusions are drawn, however, as to the practical value of this procedure. Nerve fibers cease to grow when their pressure of growth is overcome.

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