No. 3.] PERIPHERAL NERVES. 647 



We are again indebted to Letievant for the suggestion of 

 cross-suturing the long stump of two divided nerves in cases 

 where the injury is of such a nature that the nerves are cut at 

 a different level. This suggestion admits of adoption only 

 when the injured nerves lie in close proximity, as, for instance, 

 the median and ulnar. That it is possible to obtain return of 

 function after suturing the central end of one nerve to the 

 peripheral end of another, has been shown experimentally 

 by Flourens, Bidder, Gluge and Thiernesse, Philippeaux and 

 Vulpian, Rawa, Gunn, and Howell and Huber. It is evident 

 that only one of the divided nerves can in this way be regener- 

 ated, the peripheral end of the other degenerating. 



Tillmanns recommends that, after cross-suturing, the short 

 central segment should be grafted on to the long central, and 

 the short peripheral to the long peripheral. This modification 

 does not seem to me to enhance the value of Letievant's oper- 

 ation. In one experiment by the author, the peripheral short 

 segment was found to be completely degenerated, and the 

 central short stump ended in a large bulb, beyond which no 

 nerve fibres could be traced. 



{g) Resecting the Bones in the Extremity, and Stitnring the 

 Injured Nerves. — As a very extreme measure may finally be 

 mentioned a method by Lobker, that of subperiosteal resection 

 of the bone or bones in the extremity to such an extent that 

 the separated nerve stumps can be brought together and 

 sutured. The possibility of want of union between the ends 

 of the resected bones, and the fact that regeneration of the 

 peripheral end has been attained after the employment of 

 measures less formidable, should cause hesitation before this 

 method is determined upon. 



Report of Surgical Cases. 



Nothing like a complete tabulation of the surgical cases in 

 which a defect in a peripheral nerve was treated by operative 

 means, has, as far as I am aware, been made. Damer Harrison 

 has given us a list of ten cases of nerve implantation. This, I 

 think, is the largest number yet collected. 



