P.T.A.P.: Determination of Essential Lf Dosage

The treatment of painful amputation stumps by repeated percussion to the neuromata has proved successful in most cases. Of 33 cases considered suitable for percussion treatment, 19 reported good or excellent results and 5 were improved. There was only one failure in the first 15 cases treated, but in the last 18 cases, some of which were especially difficult, there have been eight apparent failures. Methods of applying the treatment are described. The neuromata are located as accurately as possible. If they are very tender the arterial supply to the stump is occluded by a sphygmomanometer cuff, as anoxaemia renders them less sensitive. Percussion is done with a mallet and an applicator about 15 cm. long. After several minutes the cuff is removed and percussion continued for 20 minutes. An electrical vibrator may be used in place of the mallet, and is of particular value in treating areas beyond thq patient's reach. Cases with cold and diffusely tender stumps should be treated by sympathetic block or section rather than percussion. Illustrative case histories are given.