Page:Proceedings of the Royal Society of London Vol 60.djvu/506

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The author treats the subject under the following heads

I. A short historical and critical review of the books and papers which have appeared on the subject from the time of Cruikshank (1776).

II. Clinical reports of four cases of secondary suture of nerves as follows:—

1. Suture of the median and ulnar nerves six and a half months after division in the middle of the forearm. There was total loss of sensation and motion in the distribution in the hand, and marked atrophic changes. Three days after the operation, sensation commenced to return ; by the nineteenth day, touch was correctly localised on all parts of the fingers ; and by the end of the first month, sensation was almost perfect. Improvement in motion was slow and imperfect.

2. Suture of the median three months after complete division above the wrist. Sensation was lost in the median distribution, and opposition of the thumb was impossible. There was marked atrophy of the thenar eminence. Two days after the operation, sensation commenced to return. Both sensation and motion speedily improved, and by the end of a year recovery was almost perfect.

3. A case in which the median, musculo-spiral, and ulnar were involved in cicatricial tissue at the seat of fracture at the elbow joint; excision of portions from median and musculo-spiral, and suture, two months after accident. There was total anaesthesia in the distribution of the affected nerves, and paralysis of the muscles. Sensation, after the operation, commenced to return on the fourth morning, but made slow progress. The case was under observation for six weeks only', at which time no improvement had occurred in motion, but sensation was present in the fingers.

4. Suture of the ulnar nerve eighteen months after division. Sense of pain was totally lost in the ulnar distribution. Five days after the operation, sense of pain returned in the little finger, and by six weeks, sensation was almost perfect, although motion had not improved.

III. Deductions from the results of operation. From the above results the author concludes that the early return