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position and be arising in muscles. mesenteridylsympatheti merve cele mai
results. The work of Cusbing, of Johns ment of the nerve fasciculi in the peripheral Hopkins Hospital; of Spiller and Frazier, nerves is considerably altered. Though of the University of Pennsylvania in this these experiments are incomplete, as they country; of Kilvington of the University of have not been performed on the human Melbourne; of Manasse of Munk's laboratory subject, I think sufficient has been done to in Berlin; of Kennedy in Glasgow, and other justify the clinical trial of the method. workers in France and Italy, has proven the It seems it would be likely to improve some practicability and possibility of nerve anas- of those distressing cases of infantile paratomosis so that grafting of a paralyzed lysis for which so little can at present be nerve upon an intact nerve will result in the done. It may be applicable, too, in some return of function of the paralyzed nerve. injuries with loss of some of the length of the
In order to better understand the princi. nerves, tumors of nerves, etc. (I would say ples underlying this practice, let me briefly that Spiller and Frazier have anticiated Kil. state that according to the present stage of vington nearly two years in applying these our knowledge, the various nerve fibres facts in a suocessful case reported before which run in a nerve trunk are grouped as the Philadelphia Neurological Society, and follows, according to Kilvington: (1) Motor of which I will speak later). nerves proceeding direot from the central ner. Cashing (Annals of Surgery, May, 1903) vous system as skeletal muscles. (2) Pre. has reported favorable results in nerve anasgangliupic fibres arising in the central nervous tomosis in facial paralysis, and in his resystem and ending in nerve cells placed port in comenting upon nerve anastomosis peripherally. (sympathetic ganglion cells, he says "In this form a given nerve with mesenterio ganglion cells and those of the normal central connections is completely heart and salivary glands, etc.). (3) Post. divided and its peripheral distribution abanganglionio fibers arising in these peripheral doned as being of comparative unimportance. ganglia and ending in smooth muscle and The central end of this nerve is then brought glandular tissue. (4) Afferent fibres arising in its entirety into connection with the periin the peripheral sensory apparatus and pro- , pberal end of the nerve considered of greater ceeding to the central nervous system; with importance, but whose contral connections these must be classified for the present, the have been destroyed. (The accessorius was vasodilator nerves.
abandoned and its central end joined to the Now, it is a fact that in nerve crossing that peripheral end of the facial nerve.) “On all of these groups may be embodied in one purely anatomical grounds, this operation is nerve, but it is the motor fibres which are suited to those cases in which a lesion of the most in evidence in the experimental work. faoial nerve bas ocourred proximal to the The experiments have been complete, and it stylomastoid foramen; and fortunately, for would be an interesting and profitable twenty operative repair, it is in this interosseous ininutes to devote one paper before this so. portion of its course that the nerve is most ciety on this subject alone. I can only men. susceptible to injury whether from disease or tion the latest publication along this line, the traumatism." conclusions of the experiments of Kilvington Cushing further says: "The length of time (British Medical Journal, April 25, 1905) whioh may elapse after the reception of an wbich are :
injury to å motor nerve and still allow of res. 1. It is possible to functionate two oppos. toration of function through nerve anastomoing groups of muscles by a single nerve, which sis is necessarily uncertain and dependent previously supplied one group only; or, to entirely upon the condition in which the musput in another way, it is possible to innervate cles have been kept by massage and electrical fairly completely muscles with a much smaller exercises. In case there has been complete number of motor born cells than usually atrophy of the muscles, so they no longer rebring about this effect.
spond to galvanic stimulation, probably no 2. When the central end of one nerve is bope can be entertained of their recovery. joined to the peripheral ends of two nerves Consequently, should there be any doubt of there are many more fibres in the peripheral the completeness and permancy of the lesion, nerves than in the central nerves, so that the as in the frequent paralyses following otitis nerve fibres in the proximal trunk divide on media in children, or the severe types of going to the distal trunks.
Bell's palsy in the adult, the muscles should 3. In some cases at least some of the be kept in tone by daily galvanism for the branobes from one nerve fibre go to supply number of months during wbich it may seem one set, and others the opposing set of mus- advisable to a wait a possible regeneration cles. This may prevent very delicate move without operative intervention. ment being restored.
In cases of undoubted destructive lesions, 4. After this form of suturing the arrange. as in a case reported by Faure, and the
writer's, the operation, of course, should be muscles with such an elaborate co-ordinate done at the earliest possible moment. The action as those of facial expression are confailure in the former case was undoubtedly cerned. It is natural that especial diffioulties largely due to the long interval, namely, would be encountered under such ciroum. eighteen months, which elapsed between the stances, owing to the complex emotional na. injury and the operation. An operation suob ture of facial movement.” as Bloodgood successfully performed in one Other peripheral nerves bave been success. instance by exposure and suture in the fully crossed in surgical practice and one of Fallopian canal of a nerve previously injured the most interesting and instruotive cases is in a mastoid operation would, except under that reported by Spiller and Young before most favorable circumstances, be difficult in the Philadephia Neurological Society in Feb. the extreme, and the procedure would hardly ruary of 1903 (Journal of Nervous and Menbe applicable for the cases in which anasto. tal Disease, June, 1903). "The case was one mosis is proposed.
of anterior poliomyelitis of two years stand. "As far as the nerve itself is concerned, a ing, in wbich the anterior tibial muscle reasonable delay in the operation need alter alone was paralyzed. in no respect, the prognostic favorability of The operation having been decided upon, the oase. Clinical experience as well as the the most important feature was the route to researches of Howell, Bethe, Ballance and be selected from a careful dissection perothers, shows tbat there is some change, sonally made, Dr. Young decided that the whether a true regeneration or not, which lateral route was the better one, and accord. takes place in the peripheral portion of a di. ingly, an incision 10 cm. in length was made vided nerve and puts it in a state of readiness downward from the head of the tibia in the most favorable for an early return of func- long axis of the leg. The incision included tion after reunion by suture. It must be re. the skin and superficial fascia. The deep membered, also that cases of suture of indi. fascia was divided upon a groove director, vidual nerves have resulted in return of func. exposing the peroneal nerve. The nerve tion, though the operation has been done was followed down, and by separating the some years after the original injury.
peroneous longus muscle three divisions "It is naturally of sonie interest to consider were found: (1) The fasciculus of the nerves in what way restoration of cortical control is supplying the upper part of the anterior brought about in transplantations of this tibial muscle; (2) the anterior tibial nerve; kind. That undiminished strength and power (3) the musculo-cutaneous perve, these divi. co-ordination will return to a group of mus. sions corresponding to those found in the oles after section and suture of their con cadaver. It was decided to take the upper trolling nerve is a common observation. It division, of wbich there were four or five fasis inconceivable, however, tbat the divided ciouli, and perforating the external division, ends of each individual nerve fibre should the musculo-outaneous, the former were once more unite in the process of regenera- united to the outer side of the latter by fine tion by perfect coaptation. Supposedly each catgut sutures. fibre is represented by a motor cell in the Great care was taken mot to injure the mus. central nervous system so that it is presum. culo-cutaneous nerve any more than necesable, under the readjustment of healing, that sary, and the fasciculi of tbe nerves which the individual cell make connection with new supply the anterior tibial muscle at its upper groups of muscle fibres. Under these cir. part were pushed through the incision in cumstances there is on the part of the indi. the external musculo-cutaneous nerve withvidual, during the slow period of motor re. out any attempt being made to separate the turn, an unconscious effort to co-ordinate the nerve fibre from the sheath instruments were early movements, which by training leads to used, and the nerves were handled as little as a perfect result. In case the nerve is grafted possible. into an entirely different motor territory, the . The nerves which were anastomosed were problem of functional restoration becomes divided as high up as possible, so that much more complex, and the training of co- there wuuld be no tension upon them. The ordination would supposedly be correspond. deep fascia was not closed with sutures. The ingly difficult. Return of well co-ordinated skin was united by interrupted sutures. Over inovement nevertheless seems experimentally the antiseptic dressing a plaster of Paris cast to have been as rapid in cases of nerve anas. was applied to insure fixation of the limb.” tomosis as in those of simple nerve division. It was my pleasure to see this case in Dr. Probably the age of the individual is a most Spiller's clinio last May, at which time imimportant factor, and without doubt the provement was decided, the child could walk younger the subject the more favorable is the almost in a normal manner and muscular prognosis after anastomosis, especially in case power was good. This case suggests the possibility of other anastomoses being performed, may be learned by the brain. In this assoand especially should we emphasize it as a ciation there must be some equilibrium es. promising operation in these unfortunate tablished between extensor and flexor mus. cases of anterior poliomyelitis where one cles, in order to have return of power. . muscle or group of muscles alone is involved. This work of Spiller and Frazier seeks to
Nerve anastomosis and transplantation is give aid in certain seleoted cases of cerebral being advocated by Spiller and Frazier in hemiplegia, and it is in the field of the cere. cases of cerebral palsy. In an address (before bral palsies of childhood where the most good the New York Neurological Society, and re- is expected, also, some possible relief in ported in the Journal of Nervous and Mental athetosis. This new possibility of neurolog. Disease, May, 1905) Spiller said: “The views ical surely commends itself in the cerebral bere expressed are original with the authors, palsies, but the selection of cases will demand and if experience proves they are fallacious, careful oversight. they may nevertheless afford some suggestions It was my pleasure to study under Osler for further investigation.” The question he and Wilmarth some years ago a series of cases propounded was, Is it possible by surgical (thirty-six) of cerebral palsies, all of which means to benefit- in any way the patient are reported in Osler's. Monograph on this afflicted with an incomplete hemiplegia ? subject, and judging from the pathological
It is beyond the most sanguine hope to findings in those cases, the number of child. give relief by surgical means in complete or ren amenable to surgical treatment will nec. almost complete bemiplegia, but Spiller's essarily be limited because of the unequal dehope is based on tbe cases where partial re- struction of motor power, and thereby lessturn of power is in evidence. It is the experi. ened possibility of establishing balance beence of observers that usually the restoration tween flexion and extension of muscles. of motion in hemiplegia is greater in the flexors in the upper limb and greater in the extensors in the lower limb, except those of the toes. An operation on the upper limb is not advised because the flexors of the fingers are
VAGINAL TAMPON. more useful than the extensors. In some cases, however, this feature is of little value
BYRON ROBINSON, M. D. unless there is at least partial return of power in the antagonistic muscles, altbough this re.
CHICAGO. turn need not be so great in the extensors as 1. The composition of the vaginal tampon in the flexors. Spiller is inclined to believe consists of a roll of medicated cotton (hen that in a cases where the flexors alone regain egg size) tied to a 12-inch string, placed in a power we might anastomose the central ends solution of sixteen ounces of glycerine and of some of the least important of the flexor two ounces of boracio acid. nerves with peripheral ends of tbe extensor 2. The duration of preparation of vaginal nerves, and in this way restore more nearly tampon should be to lie in the boroglyceride the normal relation between the flexor and solution forty-eight hours before using. extensor musole."
3. The utility of the vaginal tampon is: (a) We know from the experiments extending it is bygroscopic; (b) it serves as a mechani. as far back to the work of Fleurens in 1824, cal support; (o) it contracts tissue (muscle, that nerve crossing is both feasible and pos. elastic, connective); (d) it contracts vessels sible, and that even though the disused nerve (lymphatic, vein and artery); (e) it bastens may have been out of service for years, that absorption of exudates; (f) it checks secre. regeneration of the united ends will occur tions; (g) it stimulates; (h) it curtails inwhen these nerves have not lost their con. flammation; (i) it drains the pelvic organs; neotion with the spinal cells.
(i) it cleanses; (k) it dissolves mucus, pus Another question propounded by Spiller and leucooytes. The utility of a vaginal is, Would impulses pass from the brain over tampon depends on its composition, the quanthe central motor tracts to the anastomosed tity employed, the duration of its application, fibres in such a way that useful return of and on systematic method of use. function might be expected His answer is, 4. The methods of introduction consists in that such a restoration in part would at least placing three to five vaginal tampons (with occur. He says: “It is true that movements or better without the aid of a speculum) in and not muscles are represented in the brain the vaginal fornices in the direction of least cortex, but it has been demonstrated that resistance. when tbe lesion is in the peripheral nerves 5. Disinfectants in a vaginal tampon is and anastomosis of nerves has been per- secondary to its other qualities, especially formed, a new form of associated movements that of hygroscopy.
6. The object to accomplish by a vaginal THE RELATION OF MAN TO NATURE (A tampon is: maximum bygroscopy, dissolving STUDY PROMPTED BY "TESTIMONIÈS the elements in the discharge as mucus, pus, OF THE SEPULCHRES"). leucocytes, the mechanical removal of mor. bid secretions, accumulation and foreign
ALBERT S. ASHMEAD, M. D. bodies, diagnosis, mechanical support.
NEW YORK, 7. The diagnosis is aided by the use of a tampon by collecting and preserving the
THIRTEENTH PAPER. * uterine discharge (as pus, blood, debris).
As to Great Britain's part in the Japano8. The requirements of a vaginal tampon Russian war, there are two views wbioh may are: (a) it should be non-irritating; (b) it be taken of this subject: The first is that the should possess hygroscopio power; (c) it alliance of Great Britain (the British lion) should be a solvent of discharges (muous,
with Buddhist Japan, bas peculiar religious pus, leucocytes, blood); (d) it should aid in
signifioance to the Japanese people, in conthe dissolving of the mechanical removal of
sequence of their firm belief in a god-em permorbid secretions, accumulations, and foreign or the Mikado as an avatar on earth, that is bodies; (e) it should be aseptic (not neces- a descended or transmigrated diety into insarily antiseptio); (f) it should not indelibly stain the clothing (this is an objection to
Gautama Sakya, the founder of the Budd. its use, e. g., ichthyol); (h) it should be hist faith, or Buddba, the perfectly enlight. reasonably economio.
ened one,” even in this present "enlightened 9. The frequency of application of the
age' of Meiji, is represented in the Buddhist boroglyceride vaginal tampon sbould be in
tritych of Japan, that "three-picture carving general, twice weekly, more frequent employ on temple or household altars (the churches ment may cause irritation.
trinity), by a graven image, representing the 10. The time to apply the tampon is at
Buddha, seated on the church's lotus flower, night during maximum anatomic and physi which, in its turp, is upheld by the real ologio rest.
Avatar, of Sakya, the lion. 11. The duration the tampon may remain
The lion, therefore, represents to the Jap. usefully in position is ten to twenty-four anese Buddhist, the animal into whose body hours.
Gautama Sakya, the beggar-man of Buddha 12. There are no special contraindications
river entered after death. On the other hand, to the application of the vaginal tampon in the Mikado, a descended god, their real Ava. pelvic disease.
tar lives in a human body. Mutsubito, the 13. The boroglyceride vaginal tampon may man, is really a god transmigrated into earth be beneficially applied in: (a) inflammatory existence. He is higher in churcb author. pelvio disease (vaginitis, endometritis, myo- ity, according to the Japanese. than is metritis, endosalpingitis, myo-salpingitis, Gautama tbe beggar-man of Buddhist tra. pelvic peritontis, proctitis, oystitis); (b) sacro- dition, whose soul lives in the lion. pubic hernia (a support for the uterus, cysto. England, therefore, represents in her char. cele and reotocele); (C) in genital ptosis it acter as lion to the religious mind of Japan. depletes the lymphatics and veins.
support of the Mikado as avatar, or holy 14. A vaginal tampon applied according tc personality in the war with Christian Eu. the above directions will prove to be of ther.
How peculiarly sinister, then, must be to ease, a prophylactic agent and a comfort to the national spirit of Japan, call it Bushi-do the patient.
("'Bushi” means warfare and “do'' spirit),
or what you will, that material and moral DR. SEWALL considers the disappearance of support wbioh the alliance of the British lion the second cardiac sound at the apex as dis. affords to the Japanese in their present war tinot indication for phlebotomy.
In reality, it intensifies religious fanaticism FOR a cough with fetid sputa give creosote,
of the nation to prosecute a “war of Asia" eucalyptol, thymol, cubebin, myrtol, men.
against all Europe. thol, copaiba, or turpentine.
A second view of this unseemly alliance is DR. BUFFUM says he invariably cures as follows: scabies by washing the entire body with warm All beggary in Japan is religious in char. water containing oil of peppermint.
acter. The vagabonds in droves may be seen
usually at the approaches of the Buddhist DR. Tyson finds Dover's powder useful
and Shinto shrines, on chief festival days. remedy in the dose of 21 grains every two
The first paper of this series appeared in the MEDICAL Forthours in acute bronchitis.
NIGHTLY issue of April 25, 1905.
Here we meet the lame, the halt, the blind, keys were enough to make even the sick many lepers and other deformed wretches of borses laugh. This theatrioal combination hideous men. These beggars accompany of performing court-monkeys and Japanese their prayers for charity, with a horribly beggars, bebind a lion's skin, is indeed very doleful noise, which they make by striking anoient practice in Japan. But a real lion's little metal discs very similar to the oymbals performance, shielded from European view represented in the hands of the paper Japan only by a monkey's skin, is an innovation, ese soldiers pasted on the "monkey on a Perhaps there is more or less measure of me. stick" toy, now being sold by the street fakirs thodical substantiality in suob alliance. For in New York. Some Japanese mendicants it may be founded in the Japanese mind, at bave instead battle dores made of raw-bide, least, on the monkey showman's tricks with upon which they drum incessantly. One is the lion's skin. As for the lion, he may think inspired by all tbe din and racket they make he will be the gainer in the long run thereby, to grant their request, and get away out of but he is being made a fool of by the wily ear-shot of it as quickly as possible.
monkey. His own skin would be far better The beggars frequently take up their ob- protection for him against a bear, for instipate position on the canal bridges, or near stance, without all this deceit. For this is running streams, where they can the more not a game of play, but one of war. persistently importune the passerby to pur. Tbere are other special significations ap. chase their profered live, slippery eels or other plying to this slippery matter, than that of fish, which can readily slide from the pur the eel sold for a penny, and the beggarchaser's fingers, back to the water; and thus man's band held out for pelf, which is Japan's you are made to believe that you have per- itobing palm, and not England's. This whole formed some devout deed, by releasing them, delectable performance goes on, in Asia, as prescribed by Buddhist doctrine.
while drums are beat, triangles play, and the Among strolling beggars, we find the nose-flutes noisily blow a horrid tune, the Shosbi, or lion's skin. This is the represen. better to drive away the “evil spirits" of a tation of a lion's head, shaggy and terrible too curious European concert, which might looking, with a movable under-jaw, and a flow. intrude itself to scrutinize what really is go. ing mane, fitted on a capacious skirt, beneath ing on behind it all, or to still further conwhich a real Japanese is concealed, who works fuse and befuddle into too confiding friend. it. This lion is always accompanied by two ship for the Britisb lion, the real more natmen, one performing on a small cylindrical ural. feeling of the American eagle and drum and a triangle, the other one playing French frog for the Russian bear. the fute, usually like a Malay, with bis snuf. Viewed from any and every standpoint fling nose, instead of his mouth, and from this grotesque partnership of the monkey which they extract excruciating "music." and the lion, is uncanny-and intended
The capacious mouth of the simulated lion only to deceive the onlookers and get their is supposed to swallow evil spirits, who may money. be attracted by his gambolings and the ac- The strange alliance of the British lion companying noise.
with Japanese "wujin" (monkeys), as Li This performance of the lion is often Hung Chang called them, however, does not supplemented or varied by a performance astonish those who bave more profoundly of living Japanese monkeys.
studied the Bushido of Japanese vagabondSome strollers called Saru-mawashi, take age, in the native language of the country about with them not only the lion's skin, but of brave warriors.” real monkeys, funny looking, little red-faced Draw from in front of the present political fellows. Saru-ya-machi, “monkey-shop situation of East Asia tbe veil of opposition street," in Tokio, is their headquarters. to Russia's advance towards attainment of a
It is related that many years ago, when the warm latitudinal open port and behold bebind favorite horse of a famous “warrior” fell sick the monkey's skin of the play-man now ex(even a plain fighting man, in Japan is called bibiting his deceitful tricks in China and "warrior”), and was about to die, it was re- Corea, while his two side partners (England stored to health by a monkey, who possessed and America) collect the coin for him, a rea curative charm.
ligious dream of conquest over Christian EuSince this incident occurred, and until a rope. few years ago it was oustomary to amuse the Pull aside that monkey's skin from the horses in the stables of the higher classes,” lion's alliance with Japan, and see plainly on Japanese New Year's day, by a visit of the England's shameful anti-Russian Asiatio pol. performing "court monkeys," an example icy, grimly and nakedly exposed. The monwhich was generally followed by all the no. key's skin no more hides that lion's real purbility. These antics of Japanese court mon- pose or play, than does the lion's skin hide