The morning news. [volume] (Savannah, Ga.) 1887-1900, 1897-02-04
SUCCESSFUL NERVE GRATING.
POwerNand Feeling Restored to an
Arm ParaIyzed by Injury.

From the British Medical Journal
Robson has reported the case of gar
dener, % years of age, who sustained a
deep incision on the lower and inner part
of the right upper arm, with division of
the braohial artery, by falling on a
scythe The artery was ligated by the at
tending surgeon and the two ends of a
divided nerve were sutured. The wound
healed slowly by granulation of the wrist,
and hand supplied by the ulnar and me-
dian nerves paralzed, while those supplied
by the musculO-spiral nerve retained their
nobility Sensibility was lost in the same
distribution, and also in that of the in
ternal cutaneous nerve.
An operation was subsequently under
taken an incision being made along the
line Of the scar, and prolonged some dis
lance upward and downward, and supple
ment5d by a transverse incision about an
inch above the elbow. The lower end of
the upper segment of the ulnar nerve
which was Dubious, was found to be con-
nected by fibrous tissue with the upper
end of the lower segment. A small nerve
was found at the upper part of the
wound, which proved to be the internal
cutaneous. The lower end of the same
nerve was found subsequently and united
to the upper with a catgut suture. After
COilSluCEdbit search the buluOuS AOW0A OiiN
of the upper segment of the median nerve
was discovered at about the middle of the
upper arm, concealed by the belly of the
biceps muscle, and the upper end of the
lower segment, expanded and sending
ramihcations into the scar, was found
subsequently just above the bend of the
elbow. ~
The hbrous tissue between the ends of
the ulnar nerve was cut out, and the two
healthy portions We're united by grating
strands of the sciatic nerve of a rabbit,
50 as to fill up the gap and establish con-
tinuity. 1t was not possible to bring the
divided ends of the median nerve closer
together than 2l9 inches. In the absence
of more suitable tissue, the spinal cord
Of a rabbit just killed was used as a graft
to connect the ends of the medan nerve
the inserted cord lying loose and quite
free from tension when finally placed in
position. Fine catgut sutures were used
throughout. The edges of the wound
were brought together, the usual dress
ings applied, and the arm was fixed upon
a rectangular splint. Union took place
by first intention" with a total absence
of fever and pain.
Eleven days after the operation the pa
tient could feel the scratch of pin on
the front side of the first section of the
thumb, as well as at the root of the index
finger. He could tell when the hairs on the
back of his first sections of the ring and
little fingers were touched, but could not
feel the scratch of a pin in that situation.
Seven days later sensation had returned
over the whole of the palmar surface of
the thumb and the second section of the
index finger. After a further interval OF
sixteen days sensation seemed to be creep
ing slowly along the first finger and to be
present over the whole of the palmar area
supplied by the median nerve and extend
ing down as far as the web Of the fingers
and a short distance along the middle fin
ger. The muscles presented evidences OF
gradual development and the general nu-
triton of the hand improved. Slight power
of grasp and some power of hexion of the
wrist returned, with slight power OF bend
ing the thumb and fingers. Sensation was
present all over the thumb and index fin
ger and in the second finger up to the first
section on the palmar surface; also In the
third finger. though less distinct.
In the course of several weeks more
sharp. shooting pains began to be felt I'm
the distribution of the ulnar nerve, and
the heXor muscles of the forearm began
to react to galvanlsm Improvement thus
continued, when the patient was lost 10
observation, aud then was not seen again
until after the lapse of six years. The
man had continued the use of galvanism
for time, and did not resume his work
until more than a year after his accident.
During the subsequent five years he had
not missed a days employment attend
ing to all his duties, from wheeling WELL
laden barrow TO using a scythe on eX-
scarcely smaller than the left, and power
had returned TO all OF the muscles except
the abductor Of the thumb Sensibility
also had been restored. and the electric
reactions were normal except in the mus
Gle named.