632 HUBER. [Vol. XI. 



the injury the bleeding was controlled, and the wound closed. 

 After the dressing was removed, actual loss of sensation and 

 motion in the hand was observed. At the time of the opera- 

 tion, the ends of the divided median were found to be 4 to 5 

 ctm. apart. They were drawn out as far as possible, and, after 

 flexing the arm, he was able to bring them together and apply 

 sutures. Function began to return several months after the 

 operation. 



It will be noticed that in neither of the above cases was 

 there any loss of nerve tissue at the time of the injury. The 

 separation of the ends seems to have been due to their retrac- 

 tion, and probably also to the contraction of the cicatricial 

 tissue of the wound. I may suggest this as a reason why the 

 separated ends could, in these cases, be brought together, 

 while this was not possible in some of the cases where loss 

 of nerve tissue occurred. 



This method is by far the simplest and most natural, and 

 should in all cases be tried ; care being exercised to use 

 no unnecessary force in attempting to bring the ends 

 together. 



{b) Implantation. — The first attempt at transplantation of 

 a nerve trunk was made as early as 1869. Philippeaux and 

 Vulpian, in a series of experiments, resected the hypoglossal 

 to the extent of 2 ctm. A segment of equal length was 

 removed from the lingual of the same side, and implanted 

 between the ends of the divided hypoglossal, and retained in 

 place by sutures. Their aim seems to have been to determine 

 whether a segment removed from a sensory nerve like the 

 lingual, implanted between the resected ends of a motor nerve 

 (in their experiment, the hypoglossal) would carry afferent 

 impulses. This was tried on seven dogs. In only two of 

 these experiments did the transplanted nerve unite with the 

 resected ends of the hypoglossal. In one of the successful 

 cases, stimulation of the central end excited movements of the 

 tongue, which were more vigorous when the peripheral end 

 was stimulated. On histological examination the transplanted 

 lingual segment was found to consist largely of fibrous tissue 

 and a few medullated nerve fibres. In the other experiment 



