same time, however, that this occurs, a substance is liberated from the cells which converts the fibrinogen into fibrin. The substance which is liberated from the cells is fibrin ferment.*

ESSENTIAL NATURE OF SECRETION.

Dr. Gamgee concludes an interesting investigation into the essential nature of the function of secretion in the following words: "The complicated studies of which I have attempted to give a brief sketch have led to our forming a certain, clear, general conception in reference to the process of secretion. They have brought into greater prominence the dignity, if I may use the expression, of the individual cell. The process of secretion appears as the combined work of a large number of units. Each, after the manner of an independent organism, uses oxygen, forms CO2, evolves heat, and derives its nutriment from the medium in which it lives, and performs chemical operations of which the results only are imperfectly known to us. So long as the protoplasm is living, the gland-cell retains its power of discharging its functions, and in many cases does so as long as the intercellular liquid furnishes it with the materials required. In some cases, however, the gland-cells are especially sensitive to a variation in the composition of the nutrient liquid, certain constituents of which appear to stimulate the protoplasm to increased activity. In the higher animals the cells, particularly in certain glands, are in relation to nerves, which, when stimulated, affect in a remarkable manner the transformation of their protoplasm, leading to an increased consumption of oxygen, an increased production of carbonic acid, an increased evolution of heat, and an increased production of those matters which the cell eliminates and which constitutes the secretion.†

*New York Medical Record, January, 1883. † Lancet, September, 1882.

Report of Section on Psychology.

SUBCUTANEOUS NERVE-STRETCHING IN THE TREATMENT OF SCIATIC NEURALGIA.

BY J. W. CHAMBERS, M. D.

Subcutaneous nerve-stretching is a newly devised surgical operation, first introduced to the profession in the early part of 1882 by Billroth, for the relief of sciatic neuralgia, which latter has of late been so brilliantly treated by cutting down upon the nerve and then stretching the same, the technique of which is well known to you all.

In brief, the operation consists, as Billroth has it, in placing the patient flat upon his back, the leg extended, and then the thigh flexed strongly upon the abdomen. This puts the nerve strongly upon the stretch.

CASE I.-Idiopathic Sciatica-Subcutaneous nerve-stretching-Immediate and permanent cure. The patient, Mr. C. P., aged 50, applied at the clinic of nervous diseases at the City Hospital for the relief of the pain. History in brief: Six months ago, first noticed that in the morning he would be attacked with severe pains in the right hip, which would run along the thigh and leg to the foot. The paroxysms soon grew longer and more frequent, until finally he was compelled to take his bed for some weeks, which he was able to leave only after long rest and the faithful application of many household liniments. In short, the pain soon became constant, worse at night; walking or any movement of the leg gave rise to increased pain. Admitted to the clinic February 10, '82. Present condition: Well nourished, fells pretty strong, bowels rather confined, appetite good, great deal of pain over the course of the right sciatic nerve, walks bent over, with a cane. Respiration, temperature and pulse normal. History of the treatment.-Quinia, morphia hypodermatically, blistering along the course of the nerve, hypodermatic injections of

chloroform and ether, according to the direction of Bartholow; also large doses of turpentine-all of these remedies with little or no effect, save from the blistering and turpentine, which did seem to lessen the severity of the paroxysms.. I might add the methodical and persistent application of both the constant and interrupted currents, neither of which gave any permanent relief. April 4, 1882, operated; before operating, carefully examining the nerve. The least pressure over its course gave much pain. The patient was placed upon the table, the pelvis being strongly pressed against the plane by an assistant, while I strongly extended the leg and thigh; with the leg kept extended, the thigh was flexed on the abdomen until the toes almost touched the head of the patient. The limb was kept in this position for three minutes. The operation, which was done without the use of an anesthetic, gave the patient considerable pain, especially in the posterior thigh muscles (the biceps, semimembranosus, semitendinosus), which were somewhat stiffened for some days. Pain and tenderness over the course of the nerve ceased as if by magic. The soreness and stiffness of the muscles and tendons had entirely passed away by the 3d day. From that time to the present (October 1882, date of last note), has been altogether relieved and is following his usual occupation, which has been for the last two years a laborer in the Herring Run tunnel. The operation brought about an immediate and complete cure, after the patient had been disabled for more than four months from the effects of sciatica, notwithstanding the faithful and earnest application of all of the well-recognized methods of treatment. It will be noticed that the cure was almost absolutely complete from the moment that the nerve was stretched; the only detraction from this statement is the brief stiffness and soreness of the posterior muscles arising from the over-straining of the muscular fibres in the operation, which so readily passed off in a few days.

CASE II.-J. B., aged 26, colored, laborer on a farm, was taken ill the last of February, 1882, with severe pain which coursed along the sciatic nerve. Had been under the care of other physicians, with but little or no relief. May 16, made application at the nervous clinic of the City Hospital for treatment. Upon examining the different organs of the patient they were found normal. The pain we find shoots along the course of the left sciatic nerve; he walks lame, and the skin is in a state of hyperesthesia over a large portion of the thigh and leg; he was also found to present points of tenderness localized over the emergence of the branches of the sciatic, at the

head of fibula and over the malleoli, as well as over the point between the great trochanter and tuberosity of the ischium, with some convulsive twitching of the muscles of the left thigh and leg; in a word, all of the symptoms that make up a clinical history of a simple case of sciatic neuralgia.

Patient placed upon the table, and with the assistance of Dr. Van Note, we proceeded to stretch his sciatic nerve subcutaneously, with almost complete cessation of all of the above symptoms-pain relieved, hyperesthesia of the skin gone, in fact gave way to that of anæsthesia, though the motor power was perfectly normal, as was shown by his walking across the clinic room perfectly and comfortably immediately after the operation.

CASE III.—Mr. A. B., aged 50, intelligent and of fine physique, never had syphilis, temperate in his habits, family history good. For more than five months he had been suffering intense pain along the sciatic nerve. At first the attacks were rare, lasting but a few days. Paroxysms soon became more frequent, and the intensity increased until finally there were but brief intervals of absence of pain; during paroxysms ate but little, as he said, slept none.

Patient

The nerve was stretched as described in the other cases. complained for the first two days after the operation. Through the kindness of Dr. Coskery, and Dr. Jones, of Frostburg, Md., I am enabled to add four other cases of subcutaneous nervestretching in sciatic neuralgia.

CASE IV (case of Dr. Jones).-Male, aged 56, with sciatic neuralgia of four or five years' standing. After the first stretching he felt quite weak in the limbs, but had scarcely any pain for three weeks, when the pain returned, but not so severe. In six weeks I repeated the operation, and the pain left him, except down about the ankle, and there it remains, but is not severe.

CASE V (case of Dr. Jones) was a healthy, robust man, 40 years of age. Had been suffering from a severe attack of sciatic neuralgia for two weeks, when I resorted to subcutaneous nerve-stretching. He had immediate relief, although his left leg felt sore and very weak for eight or ten days; subsequently was as well as before the attack.

CASE VI (case of Dr. Jones).—Male, aged 50. General health very poor, has been suffering for three years with sciatic neuralgia. I have now stretched his nerve subcutaneously the second time. There has been but little improvement in his case.

CASE VII (case of Dr. Coskery).-A case of sciatic neuralgia of a month's standing, had resisted all of the ordinary means of treatment.

Have stretched subcutaneously without an anesthetic; for forty-eight hours after the operation, pain seemed aggravated, but by the third day was entirely relieved; left the hospital within a week after the operation, perfectly cured. The doctor attributes the cure to the nerve-stretching.

In the Medical News, January 6, 1883, is reported, under the head of Boston City Hospital Notes, by Dr. Royal Whitman, a case of sciatic neuralgia treated by the subcutaneous method, which was, however, followed by no relief, and the operation of cutting down upon the nerve was performed, which was followed by a complete

cure.

In the Medical News, April 14, 1883, Professor Dujardin Beaumetz, in a lecture on the treatment of neuralgia, says he has performed subcutaneous nerve-stretching upon three cases within the last year; in one, the patient was unable to walk, from an obstinate sciatica which had lasted three months; here subcutaneous nerve-stretching brought immediate and permanent cure. In the other two cases the benefit was temporary. He then concludes: "I believe, then, that in sciaticas rebellious to all therapeutic measures we are warranted in attempting subcutaneous nerve-stretching, which is doubtless a far safer operation than that of cutting down upon the nerve, as is usually done."

From the above reported cases I should take it that we are justified in stating the following conclusions:

1st. That the result of subcutaneous stretching of the sciatic nerve in rebellious cases of sciatic neuralgia is highly satisfactory. 2d. That from effects produced by the subcutaneous method, it is highly probable that all required force can be obtained. This I think I have fairly shown upon the dead subject by exposing the spinal cord and then stretching the nerve as described. Subcutan. eously the impression could by this means be readily observed to be very perceptibly affected, and from its simplicity and safety it should largely supersede the cutting method in cases where the sciatic is the nerve to be stretched.

3d. That the nerve by this method can be sufficiently stretched as to produce anesthesia, as was noted in case No. 2.

4th. That moderate elongation of a nerve impairs its sensory, and but little, if at all, its motor function.

5th. That considerable force may be applied to a nerve trunk without seriously impairing its motor function.

6th. That it is not necessary or justifiable to employ more force than just enough to produce anæsthesia.