DEPARTMENT OF SURGERY. 
925 
brought together in perfect apposition and healed by primary 
union the nerve stroma would re-connect, but the communication 
between the centre and periphery would not be immediately 
established. When the cut ends of a nerve are not widely 
separated the active proliferation of the structures comprising 
the nerve trunk may establish a re-connection, or, again, when 
the ends are even very widely separated, the active proliferation 
attending the formation of exuberant granulations will fre¬ 
quently result in the same anatomical union, but in no instance 
is there a physiological uniou of divided nerves. When a nerve 
has been divided its power of transmitting impressions between 
the seat of division and periphery is destroyed forever. The 
nerve supply of an un-nerved area is re-established by a diverg¬ 
ing growth of the axis-cylinders from the nerve stump toward 
the periphery , and such innervation is never perfect nor 
complete even after years. However, the union of the stroma 
of a nerve may facilitate the re-establishment of nerve 
supply to an un-nerved area by forming a guiding channel 
through which the new axis-cylinders may grow more rapidly. 
The importance of preventing such so-called union of nerves in 
neurotomy is not denied, as the process is no more nor no less 
than the formation of the troublesome nerve tumor. Although 
it is the sensitiveness of the connecting tissue, and not the con¬ 
nection itself, that causes the lameness, prevention of the tume¬ 
faction is quite as important as if the nerve supply were fully 
re-established. This sequel of neurotomy is prevented (i) by 
resecting the nerve well beyond the proximal commissure of 
the wound, so that the stump will not lie within the wouud and 
share in the reparative inflammation. The surgeon is too apt 
to hurriedly sever the nerve at the upper commissure in order 
to prevent the non-ansesthetized patient from struggling. Care¬ 
ful dissection and gentle traction at the upper commissure is an 
indispensable feature in the prevention of nerve tumors. At 
the distal commissure of the wound no special care is necessary. 
(2) The septic inflammation following an unclean operation is 
a potent factor in the causation of nerve tumors by encouraging 
the formation of an abundance of new tissue, nerve tissue in¬ 
cluded. Hence the neurotomy operation should be strictly an 
aseptic procedure. (3) The incision and dissection should be 
performed without mutilating the surrounding structures. The 
artery, vein and connecting areola should not be unnecessarily 
disturbed in order that the wound may heal with the least pos¬ 
sible inflammation.—( L . A. Mi) 
