ADVANCES IN SURGERY DURING THE WAR 325 



no longer is a man dismissed and sent to a dealer in artificial 

 limbs to be fitted ; his final fitting is given before he is dismissed 

 from hospital and the proper sort of device is chosen best to fit 

 the individual case, with an eye chiefly to the man's occupa- 

 tion. Also, he is educated in the use of the new appliance before 

 dismissal. The early use of the artificial leg lessens the period 

 of crutch using and obviates the undesirable " crutch habit." 



New knowledge has been acquired which assures greater 

 success in dealing with lesions of the peripheral nerves. It has 

 been ascertained that the fasciculi or smaller bundles of nerve 

 fibers, which together make up the nerve trunk as a whole, 

 have special functions of their own, and to obtain the best 

 success in suturing a divided nerve these bundles of fibers 

 should be joined to the corresponding bundles of the other end 

 in suturing, so that the special tracts will be continuous. Hence 

 the greatest care is now exercised to place the nerve in its cor- 

 rect anatomical continuity and to avoid any torsion or twisting 

 of the nerve ends in joining them. Also, it seems to be defi- 

 nitely determined that surrounding the sutured segments of 

 nerves with extraneous material, such as fascia, various mem- 

 branes, gutta-percha tissue, segments of veins, which was done 

 in the endeavor to prevent adhesions, is undesirable since it 

 interferes with new-formed blood supply to the injured portion 

 of the nerve and so retards regeneration. The best bed for a 

 sutured or transplanted nerve is vascular muscle tissue, and 

 there is a minimum of adhesions where the nerve can course 

 between the inter-muscular planes. Success has not generally 

 attended the transplantation of nerve segments; it is far better 

 to join the severed segments of the divided nerve to each other 

 when at all possible, and this is usually possible, for gaps of 

 considerable extent can be bridged by proper position of the 

 arm or leg in bringing the too short segments together without 

 tension. 



Great strides forward have been made in maxillo-facial sur- 

 gery in obtaining both functional and cosmetic results. 

 Surgeons and dental surgeons, working together to a common 



