Injuries of nerves and their consequences - Reflex Sympathetic ...

TREATMENT. 241
reported, and bring to our aid the explanation given by
Arloing and Tripier, we shall have to conclude that in
man such partition of function as they describe in animals
must be singularly rare. Thus, in one hundred and
fourteen cases of nerve section which I have collected, there
was but one instance of no loss of sensation or motion.
These rare exceptions must, then, be referred to unusual
nerve arrangements in or below the plexus, such as Krause
has described in his monograph on IsTeural Anomalies.*
The histories first quoted prove the innocuous nature
of the ligature when properly applied to nerves, a conclusion
for which I felt well prepared, from having in two
* Les Anomalies dans le Parcours des Nerfs chez I'Homme, par "W.
Krause et J. Telgmann, traduit par S. H. De La Harpe, Paris, 1869, p.
38 et seq.
According to Kobin, the filaments which enter the touch-corpuscles arise
from terminal loops formed by the median and radial. Wenzel Gruber
(Archiv fur Anat. Phys. und Wissenschaft ]Med.,iv. p. 501-522, 1870, in
Schmidt's Jahrbiicher, Bd. cl. 1871, pp. 8, 9.), to clear up the variety
of statements in regard to anastomoses between the ulnar and median
nerves, examined one hundred male and twenty-five female bodies. An
anastomosis took place in ten on both sides; in eighteen on one side
(right, 4; left, 14). It is, therefore, normal once in five-sixths extremi.
ties. In thirty-six cases there was one anastomotic branch, and in two a
double branch. Generally, there is a branch from the median to the ulnar.
Sometimes there is one from the ulnar to the median, which forms a loop
with a downward convexity.
In certain cases the median branch divides, one returning as a loop and
one joining the ulnar. This anastomosing filament supplies the flexor
profundus. It runs from the median to the ulnar below the pronator
teres, and between the flexor sublimus and profundus, and either crosses
or accompanies the ulnar artery, joining the ulnar nerve from one and
three-quarter inches below the epitrochlea to the lower third of the forearm.
Its presence does not influence the arrangements of the palmar
anastomoses. The author refers to Krause, op. cit.,andto Koland Martin,
Institutiones Xeurologicse Holmise, 1763.
3Iessrs. Pye-Smith, Howse, and Davies-Colley (Guy's Hospital Reports,
1870) describe as a variation from the normal, a branch between the ulnar
nerve and the anterior interosseous of the median.