Cordotomy for Thalamic Pain

Mr. E., a paper-hanger, married and father of one child, suffered a gonorrheal infection in 1919. In 1929, when he was 46 years of age, he was troubled one evening with a pain of moderate severity in his right hand and forearm. The following morning there was a continuous dull ache in this hand and forearm and at least every half hour a spasm of severe pain which would last for several minutes. The situation which was established that day persisted during the subsequent years. He always described the spasms of pain as though a red-hot wire were pushed beneath the nail of his middle finger, occasionally also the nails of the index finger and thumb, and pushed up under the skin of the dorsal surface of his forearm. He rarely slept more than two hours at a stretch without waking with an attack of pain. He could obtain some relief by bathing the affected limb in warm water. In 1931, two years after the onset of pain, he awoke one morning to find that his right arm was limp and useless. On getting out of bed he felt dizzy and could not use his right leg properly. There was no disturbance of consciousness. He was admitted to the Vancouver General Hospital under Doctor Sievenpiper, with a slurred speech, weakness and tremor of the right arm, and slight weakness of the right leg. Tendon reflexes were exaggerated on the nrght side and the response to plantar stimulation of the right sole was extensor. There is no note on his records of any loss of sensation, but it is recorded that there was painful over-reaction to light touch and to cold on the right hand. His blood Kahn test was positive. During two weeks in hospital and a subsequent four weeks at home his hemiparesis cleared up, but the pains in his right arm remained severe. I saw him in the Out-Patient Department first in 1935, and on many