156 



i)isc.()Vi:i<Y 



will scarcely respond to a stimulus lasting jjjj second. 

 An important practical result of this influences our 

 procedures for treatment. Such a muscle will not, in 

 fact, respwnd at all to the average effective impulse 

 derived from a faradic coil, lasting 1555 second ; we 

 are therefore precluded from the use of an ordinary 

 coil for the purpose of giving Graduated Contractions, 

 which would have been an ideal method of maintaining 

 condition in a muscle. It has not yet been ascertained 

 how long it is necessary for a nerve-path to be blocked 

 in order to render a muscle insusceptible to the 

 faradic stimulus ; during the period, however, in which 

 a nerve whose two cut ends have been sewn together 

 is in process of recovering its functions, there is a 



Fig. 4. 



tre.\tment of compou.nd fr.^cture of leg on thom.\ss 



slung from a b.\lk.-^n be.^si. 



Extension is made from a Sinclair's Foot-piece. 



(.Reproduced by kind permissioti of Messrs. Bailliere, Tindall, and Cox 



period of months during which a long impulse, such 

 as that ordinarily obtained at make or break of a 

 gah'anic current, is necessary for contraction. During 

 this period, then, daily stimulation of the affected 

 muscles is necessary, the galvanic current being 

 employed until response is obtained with the faradic 

 current ; both are then employed for a time till finally 

 the faradic current is employed alone .as described 

 under the procedure for Graduated Contractions. 

 Resisted exercises form the last stage of treatment for 

 the recovering muscles upon the return of voluntary 

 power. 



The same considerations apply, then, to the care of 

 a limb immobilised from paralysis through injury to a 

 muscle-nerve as apply to the care of a limb with 

 fractured bone. There is the same liability to 



adhesions of joints, of muscle-tendons to their sheaths, 

 and of muscle-wasting as with any other cause of 

 immobiUsation ; but the muscle-wasting is infinitely 

 more serious, the muscles require a special type of 

 electrical stimuli for their contraction, and the period 

 of treatment must continue till the nerve has been 

 repaired and is able to conduct voluntary impulses. 

 Exhaustive study, by the late Dr. Lewis Jones, of 

 the problem of obtaining a standardised instrument 

 as regards impulse length voltage and rate of inter- 

 ruption, which would supply impulses of any required 

 length, resulted in the production of his condenser 

 apparatus, which in turn has undergone some slight 

 further modifications. It is only by such an instru- 

 ment that any satisfactory investigation 

 of the exact condition of a muscle is 

 possible. With its help we can detect 

 defect in a muscle which appears to re- 

 spond well to voluntary effort ; we can 

 ascertain improvement in a muscle which 

 is still unable to respond to impulses 

 from an induction coil. It completely 

 alters, in fact, our position as regards 

 the investigation of degenerative changes 

 in muscles following enforced inacti\4ty. 

 Methods of repair of nerve have of 

 late received much attention, but must 

 be here passed over with scant attention. 

 The problem of making up for a gap of 

 several inches in a divided nerve has 

 been a constantly recurring one in war 

 injuries, and the value of nerve-grafts is 

 still subject to much discussion. Con- 

 siderations as to the method of repair of 

 nerves, the downgrowth from the proximal 

 portion into the peripheral portion (which 

 SPLINT serves merely as a pathway to conduct it 



to its destination) when the cut ends are 

 ' brought together, makes it likely that 



grafts serve a similar purpose, conducting the new 

 outgrowing fibres into the separated distal part of 

 the nerve. It is possible that other devices may 

 prove quite as successful. As implied above, long 

 periods are found to be required for the fresh out- 

 growth of nerve fibres from the cut end along the old 

 path, up to eighteen months in the leg, depending on 

 the distance they have to travel before reaching their 

 end-organ in the muscle. The nerve-fibres appear to 

 be absolutely dependent on their connection with 

 the central end for function, growth, and life itself. 



There are within sight at the present time great 

 possibilities for the use of bone-grafts. We can 

 transplant pieces of bone, with the correct technique, 

 cut them to any required shape, and implant them 

 after the manner of a cabinet-maker's art, with the 



