The Place of Operations upon the Sympathetic System in the Treatment of Poliomyelitis.

Revived interest in sympathetic surgery originated in orthopaedics. Royle's theories and operations. Their trial, failure and final abandonment. Value of sympathetic operations widely investigated; while finality has not been reached they have proved effective for three main purposes: (1) Relief of pain especially in bladder diseases. (2) Removal of inhibition and sphincteric spasm in alimentary, anal and bladder diseases. (3) Production of vaso-dilatation in (a) vaso-spastic diseases; (b) vaso-degenerative diseases; (c) conditions not due to arterial disease in which increased blood supply is beneficial.Poliomyelitis falls into the last group.-Cause of poor blood supply uncertain; ? lack of function; ? upset of some reflex; ? paralysis of vaso-dilators.TWO PROBLEMS ARISE, BOTH OF WHICH MAY BE TREATED BY OPERATIONS ON THE SYMPATHETIC: (1) The cold, blue limb, which develops chilblains, sores, or even deep ulcers every winter, often stopping treatment and requiring patient to be confined to bed. (2) The limb with considerable and rapidly increasing shortening. Sometimes these limbs show a fair return of power, and were it not for the heavy boot made necessary by the shortening, the patient could be made to walk well.Method of attack.-(1) Periarterial sympathectomy; (2) ramisectomy; (3) ganglionectomy. Physiological basis of each. Criticism of (1) and (2).Details of the operation for ganglionectomy.-Alternative approaches and their advantages. The immediate and late results of the procedure.Five cases discussed briefly.