Nerve-suturing (neurorrhaphy) : degeneration and regeneration following section : microscopical appearances : one of the Mütter course of lectures delivered before the Philadelphia College of Physicians / by De Forest Willard.

  • Willard, De Forest, 1846-1910.
Date:
1894
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Licence: Public Domain Mark

Credit: Nerve-suturing (neurorrhaphy) : degeneration and regeneration following section : microscopical appearances : one of the Mütter course of lectures delivered before the Philadelphia College of Physicians / by De Forest Willard. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    In Experiment I. it will be noticed that the sciatic nerve was severed, and the next morning the animal was walking about with great ease with- out the slightest paralysis. That union of the nerve occurred in this time I could not believe, and subsequent examination showed that a portion had been left uncut. Unfortunately, I did not see the dog after he recovered from the ether, and do not know whether he walked at once. In cases where portions are excised, rapid union may take place by means of multiplication of the sheaths, if there is but little fatty degenera- tion of the peripheral ends. Experiments seem to prove not only that transmission of nerve-force is possible to be secured, but that degeneration is also prevented by suturing. Gluck’s experiments show that union in a fowl is much more rapid than in a rabbit, and more rapid in the rabbit than in the dog; therefore, in man even greater delay may be expected. Clinical facts prove that there are instances of nerve union in seventy hours in the fowl, while in man resto- ration is not accomplished for several weeks. It is but seldom, fortunately, that we have an opportunity for examina- tion, microscopically, of the effect of nerve-section in man within the first few weeks, and results, therefore, must be determined by symptoms. We are justified, however, in believing that union has occurred in the continuity of a divided nerve when there is restoration of sensation, absence of atrophy of the muscles, and the presence of contractility. Clinical records show most decidedly that union does and may be expected to occur. An inch may be excised with the expectation of good results in from six to twelve months. Clinical facts prove that the views formerly entertained by neurologists in regard to nerve-union are wrong, and that with the speedy repair obtainable by antiseptic methods reunion and regeneration are possible. Certainly we can hope for good results with care and attention to detail, and by accurate approximation of the divided nerve and retention by fine catgut sutures. Suture of a nerve after many months of separation of the divided ends may result in restoration of the functions, even if there is no resultant con- tinuity of the axis-cylinders; to apply one axis-cylinder absob1 ely to its original is impossible. Even if no nerve-union takes place, nerve-regener- ation seems slowly to occur, as axis-cylinders are formed, with later deposit of myeline, as has been accurately described by Neuman. Howell and Huber,1 in a careful and most comprehe’ ive study of the subject, have entered into the physiological, histological, and clinical study of both regeneration and degeneration of nerves. Their investigations were undertaken especially to learn, first, whether union and return of function of severed nerves without degeneration of the distal portion is possible, and, secondly, whether union is possible with re- turn of function between the central portion of any one special nerve and the 1 Journal of Physiology, 1892, vol. xiii. No. 5 (Mitchell Prize Essay).