SUGGESTIVE CASE OF NERVE-ANASTOMOSIS. 319 



A SUGGESTIVE CASE OF NERVE-ANASTOMOSIS. 



By Professor GEORGE T. LADD, 



YALE UNIVERSITY. 



SUCCESSFUL cases of the anastomosis of motor nerves presiding 

 over different groups of muscles have been several times reported 

 since 1897. Some of these cases have resulted in the transference of 

 function between the flexor and the extensor nerves of the same ex- 

 tremity; in other cases, nerves serving so different purposes as the 

 sympathetic and the imeumo-gastric have been successfully crossed. 

 The anastomosis of mixed nerves offers, of course, a more complicated 

 problem. 



In 1898 Dr. Faure attempted to cure a case of facial paralysis due 

 to destruction of the Nervus facialis by uniting its peripheral end with 

 that portion of the Nervus accessorius which supplies the trapezius 

 muscle. But in this case a satisfactory restoration of the function of 

 the facial nerve was not secured. Still later experiments upon 

 animals in Munk's laboratory, with a view to effect a functionally 

 satisfactory anastomosis of the same two nerves, resulted in a partial 

 success. And one instance of this particular operation in the case 

 of a man, which was attended by a somewhat marked recovery of 

 function, was communicated to the Royal Society by Dr. Kennedy, of 

 Glasgow, in November, 1900. The same authority reported several 

 instances of the same class of cases in the London Lancet for March 

 1, 1902. In one of these cases, Dr. Kennedy, operating " for facial 

 spasm, divided the facial nerve and united it to the spinal accessory 

 with the result that the face recovered its power of movement to a 

 great extent, but that whenever the patient lifted the right arm a 

 spasm of the face was produced." 



The case of anastomosis, to which I wish now to call your atten- 

 tion, was performed by Dr. Harvey Cushing of Baltimore, in the 

 spring of 1902 ; and it consisted in transferring the proximal stem of 

 the divided accessory nerve in toto into the distal end of the injured 

 and paralyzed facial. The injury to the facial nerve was in this case 

 caused by a bullet wound which completely severed the nerve on the 

 right side of the face; and it involved a loss of the sensations of 

 sweet, sour and bitter substances over the anterior two thirds of the 

 tongue on that side, and a total motor paralysis of the same side. 

 The patient could not close his right eye; lachrymation and other dis- 

 comforts of facial paralysis were present; and none of the muscles 



