1906.] 



Regeneration of Nerves. 



267 



regenerate independently of the central nervous system have been certain 

 surgeons.* The statements made by clinical observers that in man (including 

 adults, in spite of Bethe) sensation rapidly returns after freshening up and 

 suturing together the ends of a nerve which has been divided a long time 

 previously would be very valuable evidence in favour of the " peripheral 

 theory " if it was entirely trustworthy. Since commencing this enquiry, one 

 such case recently in King's College Hospital was carefully observed by one 

 of us (A. E.) and it throws useful light on the subject. The case was not 

 one of actual division, but compression, which comes to much the same thing. 

 Two thick silver wires put on to secure the ends of a fractured humerus had 

 included the musculo-spiral nerve. The operation consisted in removing 

 the wires and freeing the nerve from the scar. A short time afterwards the 

 man stated he was again able to feel, but these sensations rapidly subsided 

 and sensation did not really return until months later. The preliminary 

 sensation was doubtless subjective ; the irritation of the nerve-fibres in the 

 scar lasted some hours, and the sensations so produced were referred by the 

 patient's mind to the original terminals of the fibres. 



At the meeting of the British Medical Association in Oxford in 1904, 

 Dr. Kennedy,f of Glasgow, brought forward a number of cases in support of 

 the autogenetic theory. Here again, the genuineness of the early recovery 

 is doubtful ; in spite of sensitiveness to such tests as needle pricks there is 

 usually absolute anaesthesia to the far more delicate test of stroking the hairs 

 over the affected region until quite late dates. Head and SherrenJ have 

 also recorded a number of surgical cases, but they found no evidence of 

 early recovery ; they showed by very careful work that there is considerable 

 difficulty in localising the stimulus so that it should not affect the 

 hypersesthetic marginal zone of the anaesthetic region, and also that the 

 deep sensibility of the subjacent parts, such as would be excited by needle 

 pricks, is entirely independent of cutaneous sensation. The fibres subserving 

 this form of sensation run mainly with the motor nerves and are not 

 destroyed by division of all the nerves to the skin. Neglect to recognise 

 these facts will no doubt explain the results recorded by Kennedy and those 

 who have published similar cases. 



The difficulty of obtaining absolutely trustworthy evidence from patients 

 themselves induced Head§ to combine with his experiments on animals and 



* See, for instance, Bowlby, ' Lancet,' 1902, vol. 2, pp. 129, 197. 



t 'Brit. Med. Journ.,' 1904, vol. 2, p. 729; see also E. Kennedy, 'Phil. Trans.,' B, 

 pp. 188, 257 (1897). ■ 



1 ' Brain,' vol. 28, p. 117 (1905). 



§ Head, Rivers, and Sherren, " The Afferent Nervous System from a New Aspect," 

 Brain,' vol. 28, p. 99 (1905). 



