Co-ordinated Movements after Nerve Crossing, ctr. 433 



the centres on the left sigmoid gyms showed that the flexion centre had 

 l>ecome an extension centre, but no flexion centre could be discovered. 



In these experiments (II, III, IV) the centres on the right side of 

 the brain were normally placed. 



In all the experiments the irritability of the centres on the left side 

 of the brain was increased rather than diminished. 



In addition to these experiments on nerve crossing, there was also 

 an experiment made on a dog to ascertain if the fact of crossing the 

 nerves delayed the functional recovery beyond what would be expected 

 merely as a result of nerve section. In this experiment the same 

 nerves were divided, but were immediately reunited as accurately as 

 possible. The result was that the course of recovery of function was 

 not materially different from the course in the experiments on nerve 

 crossing. 



The physiological examination showed that the nerves had united 

 well, and regained their normal irritability and conductivity, and that 

 the muscles of the limb were healthy. Examination of the cerebral 

 cortical centres showed that they were not well defined, but neither 

 were they on the sound side in this animal. 



II. Junction of the Peripheral Segment of the Divided Facial Nerve with 

 the Trunk of 'the Spinal Accessory Nerve for the Treatment of Facial 

 Spasm in a Woman. 



The experiments on dogs having shown that nerve crossing was 

 'followed by recovery of co-ordinated function, the following operation 

 was undertaken for the treatment of facial spasm in a woman. Faure 

 <'uid Furet had already suggested utilising the branch of the spinal 

 .accessory to the trapezius for the supply of the face in the case of 

 paralysis of the facial nerve, arid Faure* had put the operation in prac- 

 tice, but without success. In the following case the patient had suffered 

 for ten years. The right side of the face was incessantly twitching, the 

 angle of the mouth being permanently drawn up, and the eyelids half 

 closed. The condition had been under treatment at different periods, 

 but without any success. Rather the condition got worse. 



On May 4, 1899, the facial nerve was divided close to its exit from 

 the aqueduct of Fallopius, and grafted on to the trunk of the spinal 

 accessor} 7 , just as the latter nerve emerges from under the posterior 

 belly of the digastric muscle. The digastric situated between the 

 central end of the facial nerve and the junction with the spinal acces- 

 sory prevented any reunion of the nerve. 



Immediately after the operation, the right side of the face was in a 

 condition of complete paralysis, and it remained in this condition for 



* Faure, "Traitement Chirurgioal de la Paralysie Faciale par 1* Anastomose 

 Spino-faciale," ' Eerue de Chirurgie,' vol. 18 (1598), p. 1098. 



VOL. LXVII. 2 1 



