630 HUBER. [Vol. XI. 



These cases must, however, be looked upon as exceptions, 

 and not considered as disproving the general principle laid down. 



In the great majority of cases the surgeon will have no 

 difficulty in bringing the divided ends of a nerve together and 

 applying a suture. The injuries to which peripheral nerves 

 are exposed (among which may be mentioned cuts with sharp 

 instruments, glass or saws, gunshot wounds, etc.) are of such 

 a nature that not much nerve tissue is removed. This is, 

 however, not always the case. In laceration wounds of an 

 extremity several inches of a nerve may be destroyed ; in 

 removing tumors involving nerves the resected ends may be 

 far apart, and again, in cases where inflammation and suppura- 

 tion follow injury to a nerve, the stump may become so 

 imbedded in a mass of cicatricial tissue that without long and 

 tedious dissection the severed ends cannot be found : at such 

 times the surgeon cannot resort to nerve suture. 



A number of methods have from time to time been suggested 

 to obviate the difficulties arising in such cases. To try these 

 methods experimentally, and to establish if possible their 

 comparative value, has been the object of this investigation. 

 Much experimental work dealing with these questions has 

 already been done. A review of this work, with a table giving 

 some clinical cases, will form the first part of this paper. The 

 record of the author's experiments, and the physiological 

 observations made, will be presented in the second part ; and 

 the results of the microscopical examinations in the third part. 

 It is hoped that the subject maybe more clearly and completely 

 presented in this form. 



Part I. — Review of Literature. 



The various methods which have been employed in the 

 treatment of nerve injuries with loss of nerve substance may 

 best be grouped under the following heads : — 



{a) Nerve stretching (Schiiller). 



{b) Implantation of a nerve segment removed from a recently 

 amputated limb or from one of the lower animals. 



{c) Tubular sutures (Vanlair), 



