NATURE 



501 



THURSDAY, AUGUST 28, 1919. 



WAR WOUNDS. 



^i) Traits Clinique de Neurologic de Guerre. Par 

 Paul Sollier, Chartier, Fdlix Rose, Villandre. 

 Preface de M. le M^decin-Inspecteur Baratte. 

 Pp. viii + 830. (Paris: Librairie Felix Alcan, 

 1918.) Price 32 francs. 

 ') Annales de la Clinique Chirurgicale du Prof. 

 Pierre Delbet. No. 6. Biologie de la Plaie de 

 Guerre. Par Prof. Pierre Delbet et Noel Fies- 

 sing-er. Pp. v + 460 + 4 pis. (Paris: Librairie 

 F^lix Alcan, 1918.) Price 30 francs. 

 (i) 'T^HE publication of the work carried out in 

 J- the Neurological Centre of the Four- 

 teenth Region (Lyons) during the period Decem- 

 ber, 1914, to March, 1918, is a welcome addition 

 to the neurological records of the war. More 

 than 18,000 patients were examined during this 

 time, and nearly half of these were actually in 

 hospital under the care of the staff of the Centre. 

 More than 11,000 cases were followed up, and 

 the statistics of these are available. 



The organisation of the Centre, with its many 

 special departments, under one administrative 

 head, has ensured a unity of purpose during- the 

 whole time of the patients' treatment. The co- 

 ordination of special medical and surgical depart- 

 ments with those of radiology, electro-therapeutics, 

 -e-education, etc., is especially insisted upon. In 

 this country the chief attempt at such co-ordina- 

 tion has come through the establishment of special 

 hospitals for orthopaedic cases, and such units 

 have been an unqualified success. 



M. Chartier discusses head wounds, and notes 

 that the use of the steel helmet not only reduced 

 the incidence of such wounds, but also diminished 

 the proportion of severe penetrating wounds of 

 the skull. It is emphasised that foreign bodies 

 after lying latent in the brain for months may at 

 length give rise to serious cerebral conditions, 

 such as abscess or apoplexy. 



The ordinary facts of cerebral anatomy and 

 physiology are shortly described in relation to 

 lesions of the brain. Reference to the work of 

 Head and Holmes is omitted in the description of 

 the cerebral sensory functions. The classification 

 of aphasia according to Marie and Foix is 

 adopted, although no new facts are mentioned. 

 Traumatic diabetes and polyuria are shortly dealt 

 with, although the influence of the sympathetic 

 nervous system and adrenal glands receives no 

 recognition as playing an important part in the 

 production of this form of glycosuria. 



M. Villandre ably deals with the surgical treat- 

 ment of head wounds, including late repair of the 

 skull by bone and cartilage grafts. A feature of 

 this section is the full description of X-ray diag- 

 nosis. This author also gives an account of the 

 surgery of the spinal cord, with details as to 

 technique. 



The chief diseases and injuries of the spinal 

 NO. 2600, VOL. 103] 



cord and plexuses are described by Dr. Fdlix 

 Rose. The diagnosis is not very fully discussed, 

 a notable omission being the bulbo-cavernosus 

 reflex in the diagnosis of injuries to the cauda 

 equina. The paragraphs on polyneuritis do not 

 describe cases with symptoms similar to those 

 recently published as "infective polyneuritis" by 

 British observers. 



M. Chartier gives an account of the lesions 

 of the cranial nerves and those of the 

 upper extremity. The anatomical arrangement 

 of nerve-fibres in peripheral nerves is men- 

 tioned in connection with the work of Dejerine 

 and Mouzon and that of Marie and Meige ; no 

 personal experiences are given. Most observers 

 in this country would dispute the statement that 

 in complete lesions of the median nerve the nail 

 pulp of the middle finger remains sensitive to 

 pressure pain. The periarterial sympathetic fibres 

 are suggested as the pathway for this sensation, 

 although no proof of this view is attempted. 



In the section on "Causalgia " singularly little 

 personal experience is quoted, and the sym- 

 pathetic system is again called in to explain the 

 important features of this syndrome. The original 

 suggestions of Weir Mitchell are much more in 

 line with the clinical findings in these cases, and 

 the treatment by removal of the sympathetic 

 nerves as advocated by Leriche has not been a 

 success in this country. The author does not 

 mention the frequent innervation of muscles such 

 as the first dorsal interosseous in the hand by 

 other nerves than those usually described, a fact 

 which may complicate both diagnosis and prog- 

 nosis. 



All observers in this country are much struck 

 with the manner in which the function of para- 

 lysed muscles can be taken on by alternative 

 muscles not usually associated with the chief 

 movements of joints. M. Chartier does not em- 

 phasise these phenomena in connection with 

 diagnosis and prognosis. 



MM. Villandre and Sollier deal with the 

 surgical and medical treatment of nerve injuries 

 resf>ectively. Before operation they insist upon 

 neurological, electrical, and, if necessary. X-ray 

 reports. An interval of two and a half to three 

 months is allowed to elapse after the healing of 

 the wound before nerve suture is undertaken. 

 There is no insistence upon re-examination at 

 regular intervals for signs of regeneration, 

 although this routine is essential to accurate 

 treatment. The section on electro-diagnosis is 

 complete. The ordinary tests by faradism and 

 galvanism have been most used, although the con- 

 denser and chronaxie methods are mentioned. 



The chapters by P. Sollier on the functional 

 disorders are the most interesting in the whole 

 work. Personal experience is freely quoted in 

 the text, which is also well illustrated by original 

 photographs. The writer objects to the view that 

 the basis of all "functional" disorder is 

 "psychic." The physiological basis of hysteria is 

 stated in full. In common with Roussy, 



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