Muscles by Means of Nei^ve Anastomosis. 



333 



was the common source of supply, thus enabling the leg to be earlier held 

 extended, and therefore useful for walking. 



Each experiment was investigated before the animal was killed, as 

 follows : — 



A. Examination of the Nerves. — In every case the union of the nerves had 

 taken place as intended, i.e. no reunion of any nerve intended to be 

 eliminated had occurred. Also it was found that when the musculo-spiral 

 trunk was supplying both flexors and extensors, it conveyed the fibres for 

 the flexors and those for the extensors along different sides of the nerve, 

 where they could be separately stimulated. 



B. Examination of the Brain. — In every case in which this examination 

 was able to be made, namely, in one of the first type of experiment and 

 in two of the second, the centre at which stimulation normally produces 

 contraction in the muscles of the eliminated nerve supply was inexcitable, 

 and in the other centre (either the normal flexion or the normal extension 

 centre according to the type of the experiment) both flexion and extension 

 were evoked, and at no point in the centre could separation of these move- 

 ments be obtained. 



The operation which Nicoladoni introduced for cases in which infantile 

 paralysis has destroyed the function of a group of muscles presents the 

 same problem as do cases of nerve anastomosis. This operation consisted 

 of substituting for the lost muscles a portion of a neighbouring muscle so as 

 to regain some of the lost function, and if the lost function or a part of it can 

 be thus regained, it can only be by the nerve supply of the muscle from which 

 the substitute is taken altering its function so as to cause the movement 

 proper to the paralysed muscle instead of that normally belonging to it. 



A case in which the author performed this operation was carefully examined 

 in order to exclude sources of fallacy. The function of the extensors in the 

 leg was lost and a talipes equinus by contraction of the gastrocnemius was 

 present. This was in a girl aged 7, and had lasted for six years. The extensor 

 muscles gave no reactions to electrical tests. At the operation the gastroc- 

 nemius was lengthened to overcome the talipes, and one-third was taken from 

 the outer part of that muscle and attached in front to the tendons of the 

 paralysed muscles. Sixty-nine days after the operation the patient had 

 power to extend the foot voluntarily, some eversion being produced at the 

 same time owing to the line of action of the new muscle. The new muscle 

 also stood out as a tense band while the voluntary movement was being- 

 performed. The two separate movements were also able to be evoked by 

 galvanic or faradic stimulation over the two separate parts of the gastroc- 

 nemius. After the recovery of voluntary extension a further examination 



2 c 2 



