tions of Professor Béclard; in which accidents of this kind were followed by exquisite symptoms: of this last, we subjoin a condensed translation. Case. A man, about fifty years of age, had a large aneurism in the ham, for which the femoral artery was tied near the middle of the thigh: a flat ligature was applied, cut short, left 60 hours in the wound, and then withdrawn: pulsation instantly subsided in the tumour, and never returned; but the blood's circulation was not re-established in the lower parts of the member, and gangrene supervened: it seized the foot, and greater portion of the leg. "Separative inflammation" now exhausted the patient, and brought his life into imminent danger: this led to amputation of the thigh; and, among the "multitude" of superficial arteries requiring to be tied, was that which passes between the branches of the ischiatic nerve. The wound healed almost entirely by the first intention, and the cure was nearly complete when tetanus assailed the sufferer and destroyed him, notwithstanding the employ-. ment of many energetic remedies. On inspection, the arteries generally were discovered to be indurated and (“calcaires") ossified: the sciatic nerve, on being examined at the stump, exhibited a considerable enlargement, which included the knot of a ligature that had not been detached. This person had formerly sustained an injury of the radial nerve. Does the author, by making this remark, propose to intimate that frequent nervous lesions tend to induce the tetanic predisposition? Dr. Descot is of opinion that the effects produced on the nerves by affections of the teeth may have some relation to those determined by the lodgment of foreign substances; and, out of a great number of facts confirmative of this proposition, relates one communicated by M. Briquet: as, however, we do not perceive any thing very remarkable in it, we shall proceed to— CHAP. VIII- On the Ligature of Nerves. Lesion of a soft part, produced by a ligature, is soon followed by infiltration, above, below, and around it, of an organizable substance, like that which agglutinates wounds: the tissues inclosed in a ligature inflame, soften, become liquified, so to speak, and are divided, more or less speedily, according to their nature and size; and the swelling and hardness of the surrounding parts gradually subside on the ligature being expelled, and go into that state which succeeds the healing of a wound made by a cutting instrument. The ligature of a nerve, however, presents some peculiarities at the instant of its being tied, the nerve contracts distinctly; without doubt, says our author, from the interruption of continuity produced immediately in the softer parts of the organ: the membranous structure which remains inclosed in the ligature offers so much resistance that it is absolutely impossible to cut it through immediately, however great a degree of constriction be applied. Ligature of a nerve occasions intense pain, usually accompanied, in the lower animals, with excretion of urine and fæcal matter, and an interruption of the nerve's functions; when it is tied suddenly, the results are little different from those which proceed from division of the organ with a sharp instrument: several facts are adduced in support of these state ments. Valsalva and Morgagni tied the par vagum of a dog, and soon afterwards untied it, but the animal died in five hours: the nerve had become thicker than it was before the application of the ligature. The former ascertained, that dogs expire much sooner from ligature of nerves than their section: he tied the eighth pair, in a young bitch, near the larynx; the animal instantly lost her voice, and, although the ligature was soon removed, and the edges of the wound kept in apposition by Nature, she never recovered it: tormented with efforts at vomiting, this animal died in eight hours after the operation. Having tied the same nerves in a dog, the ligature, which he drew very tight, was instantly unloosed; nevertheless, the animal began soon to vomit, and expired in 14 hours, making strong attempts to evacuate the stomach, and discharging frothy blood from its mouth. On removing a ligature, we observe a depression on the nerve, but at the end of a few days this is effaced, and the part appears thickened. Galen had remarked, that a tight-drawn ligature induces a partial section of the nerve; so that, though it be soon withdrawn, the functions of such nerve are not the less suspended: it is only in cases where the ligature has been imperfectly tied, or consisted of an elastic substance, that the nerve's functions have ever been regained: this fact explains the circumstance of Vesalius, Columbus, Casserius, and Rialamus, having known the voice to be restored, on untying a ligature from the recurrent nerve: it also explains the results of Bidloo's and Stokhausen's experiments, that ligature or even section of the sciatic nerve does not destroy motion and sensation in the whole limb. Ligature of a nerve, even a large one, our author says, does not give rise to the convulsions, spasms, and other "grave accidents," which pathologists have been in the habit of ascribing to it: when allowed to remain on the nerve, it has the same effects as an incision; it occasions a breach of continuity and suspension of function: this is exemplified in three "observations" from Mollinelli's work on aneurism, but we have not space for their transcription. Dr. D. proceeds to observe, that a ligature applied to a nerve determines, at the same time, above, below, and around the place, an effusion of coagulable matter, and especially an "ovoid" enlargement in the superior end. There is error, therefore, he adds, in the statement of Bidloo and others, that this enlargement ("gonflement") exists principally below the ligature: this enlargement is quite manifest at the end of a few days, after which it becomes vascular: the ligature, at the end of an uncertain, but not long period, divides the nerve, and is itself detached: then the two ends, retained in exact contact, and, as it were, united externally by a thickening of the surrounding cellular texture, and the deposition of coagulable matter, soon re-unite in the centre of the separation from which the ligature had just been evolved. In such cases, there is never, as in section of the nerve, a separation or displace ment of the two extremities: these remain always in perfect relation: for, when they have been totally divided by the ligature, they are already in part re-united around it. The swelling of the surrounding parts is gradually and completely resolved; that of the nerve, on the contrary, continues, principally above where the ligature was applied: this enlargement, says Dr. D. was found in the median nerve at the end of thirty years, after it had been tied along with the brachial artery: he views these facts as being established by the results of certain experiments and dissections, which afford some really interesting details. When the ligature on a nerve remains in its place, the fact enters into the class of "Wounds of nerves complicated with the presence of Foreign Substances," and should be held as the cause of unfavourable symptoms. In some instances, a second amputation has been practised with the design of removing the violent pain experienced in the cicatrix of a stump, Sommerring ascribes pain of this kind to the tubercle which forms on the extremities of nerves divided in amputation; but it appears, from the researches of Van Horn and Breschet, that the tubercle is not the cause of such pain. When the ligature has been evolved, ought we not, our author enquires, to attribute the continuation of the pain to the existence of a fibrous cord comprised in the enlargement of the nerve in the tissue of the cicatrix? There can be no reason, he adds, why this phenomenon should not have place after section of a nerve with a ligature, as well as after its section by a sharp instrument. He then enumerates some 66 facts," to prove that, in proportion with the re-union of the ends of a nerve divided by ligature, its functions, at first suspended, are gradually recovered, and, in the issue, become perfect one pathological history illustrative of this, from the practice of M. Richerand, deserves every consideration, but its length precludes our offering the homage of a transcription to its merits. Some persons believe that the favourable results of a ligature on a nerve can only be obtained when, in the same parts, there are other nerves, which, by their anastomoses with the former, are enabled to supply their functions. In our author's mind, however, this " "hypothetical proposition" is inexact; and he regards, as being more conformable to facts, the doctrine, that ligature, as well as every interruption of continuity and function in a nerve, does not endanger life, so long as such nerve is merely the "conductor" of sensation and motion; and that if the patient survives, the re-establishment of its continuity and functions takes place: nevertheless, he adds, some authors suppose that certain ligatures become more dangerous when anastomoses are defective. The ligature, and every other division of a nerve whose functions are essentially vital, as the pneumo-gastric, cannot be made on both sides of the body at the same time without occasioning sudden death: the process of re-union is then impracticable. But if the experiment is performed on one side only, and the animal survives, re-union takes place, and in a reasonable time the same thing may be done on the other side. Others have taught, that the simultaneous ligature of the principal nerve and blood-vessels of a member must necessarily be succeeded by : its becoming gangrenous: but, says Dr. D. we should carefully ascertain how much truth there is in this general proposition, and how many circumstances, in such a complicated lesion, ought to be referred to each of the particular lesions of which it is composed. On this head, he comes to the three following conclusions: 1st. We know positively, that in a healthy subject, and not very old, the ligature of the chief artery of a member produces only a very "momentary" suspension of the circulation, which is soon re-established by the collateral branches: 2dly, It is absolutely the same in regard to a principal vein, although some modern surgeons have asserted the contrary: and, 3dly, It is likewise the very same with respect to an important nerve; its functions are recovered" some time" after it had been tied. Now, he inquires, what shall be the result of a simultaneous lesion of the vein, artery, and nerve? This question leads him to review the experiments instituted by Valsalva for the purpose of refuting Varignon's assertion, that animals die instantaneously of apoplexy, on both nerves of the eighth pair being tied he holds the results to be quite conclusive, and proceeds to state the effects of three experiments practised by himself on living animals. In the first, the injuries were too complicated to lead to any positive result; nevertheless, although the dog survived for six days, gangrene did not supervene in the members whose nerves and blood-vessels had been tied or cut. In the second, where all the nerves of the brachial plexus, as well as the arterial and venous trunks of the same member, were altogether tied, palsy of the member ensued; but, fourteen days after the application of the ligature, no symptom of gangrene or of infiltration had appeared: the limb, however, remained in a state of flexion, and the paralysis continued. In the third, which consisted of the same operation as the last, a most acute pain was felt instantly on the ligature being applied, and palsy, also, of the member immediately supervened; but, by the fourteenth day, when the animal was killed, no troublesome symptoms had arisen. On inspection, the brachial plexus of nerves and deep-seated blood-vessels were still firmly enclosed in the ligature, but the member, although carefully examined, did not exhibit any morbid alteration whatever. In three other cases, Dr. D. isolated the sciatic nerve, and applied a ligature to its trunk; but in one of them only was the process followed by mortification of the extremity of the member in this, the dog was old, and the nerve tied at its issue from the ischiatic notch. The chapter closes with the sketch of a case which Mr. Swan adduces, to shew how little capable the anastomosing branches are of transmitting the nervous influence after the division of a nerve with a sharp instrument, or a ligature which produces the same results. : CHAP. IX.-Cauterization of Nerves.-Cauterization, whether it results from the application of concentrated caloric, or of any caustic substance, produces an eschar, the separation of which is equivalent to a wound with loss of substance. Nerves are rarely, if ever, the exclusive subjects of burning or cauterization: when injured in this way by themselves, or simultaneously with other soft parts, they are converted into an eschar, on the detachment of which there remains, between their two ends, a space proportionate to the extent of structure thus destroyed; and, in general, the cicatrix that closes the wound does not restore the nerve's continuity or functions. For this reason cauterization is usually preferred in cases of neuralgy, and most frequently determines favourable results, while simple incision is too often followed by a relapse. Dr. D. induced this kind of lesion in animals; in one instance, where the cauterization was very superficial, the nerve's functions were not destroyed; in another, complete cauterization instantly occasioned palsy of the limb. The history of both these experiments is given, with an account of the nerve's appearances in the latter, on the twelfth day after it had been injured. The animal walked on three feet, the palsy of the other being complete; the nervous trunk was completely divided across, and a space of more than an inch existed between the two ends; the upper was slightly thickened and flattened; the lower exhibited no traces of having been cauterized; and both of them adhered strongly to the surrounding parts, with which they were intimately blended. Additionally to these, illustrative of the same doctrines, our author relates a case of maxillo-dental neuralgy cured by the actual cautery; the patient, a lady of 50, afterwards enjoyed the "best" health. CHAP. X.-Re-union of Divided Nerves.-When a nerve has, by any means, been perfectly divided, the two ends readily unite, if they are allowed to remain in apposition. This fact, which is common to all organized and living structure, is incontestable; but, says Dr. D. it has been the subject of much investigation to ascertain whether the cicatrix is of the same texture, and performs the same functions, as the nerve itself; and especially when there is distinct loss of substance, whether a regeneration of true nervous tissue really unites the two ends. Our author goes very comprehensively into this inquiry; and, for the sake of precision, divides this section of his book into two parts. In the first, he states the facts, opinions, doubts, and conjectures of the greater part of physiologists-including Fontana, Monro, Michaelis, Arnemann, Cruickshanks, Haighton, Reil, Meyer, Zimmermann, Sommerring, Meckel, Boyer, Richerand, Delpech, Callisen, Monteggia, Swan, and Breschet, who have written expressly or generally on the re-union and regeneration of nerves. And, in the second, he " exposes the results of his own observations." We must, however, pass over the former entirely, and restrict our account of the latter to a brief but faithful outline. Re-union of the lips of a wound, our author observes, presents phenomena which are general or common to all the tissues and all the organs which have been simultaneously implicated. When a wound, for instance, divides the skin, cellular and subcutaneous adipose tissues, aponeuroses, muscles, nerves, blood-vessels, and lymphatics, and the edges of it are brought together and kept in exact contact, this wound, |