Neurosurg Focus 28 (5):E24, 2010
1The re-growth of a severed nerve is a romance. It is, perhaps the most beautiful example of Nature's power of repair, but it cannot be hastened by artificial means. It is a very delicate process, easily arrested or retarded: it follows certain natural laws, which take a long time to work out. After the surgeon has removed the obstacles, which forbid Nature to begin her beneficent work, all that he can do is stand on guard to see that nothing shall be allowed to interfere with Nature.
Sir robert JoneS
33Sir Robert Jones, a respected British orthopedic sur geon and beloved teacher, waxed eloquent about the pe ripheral nerve in 1918. By this time, the central role of PNIs to his concept of comprehensive management of war injuries was apparent to the casualty, medical officer, War Office, and government; in fact, all the stakehold ers in military medicine. Complex historical issues of specialization, which were not readily apparent in earlier wartime medical organizations, were important elements of this expansion. 4,66,68,78 In this report I will outline the buildup of the sophisticated treatment of PNIs during World War I, even though these injuries seemed unlikely candidates for attention during a global war.
69The Unassuming Peripheral NerveAssociated with the emerging specialty of neurology, a surprising number of elaborate investigations described the anatomy and clinical examinations of the peripheral nervous system during the 19th and early 20th centuries. Descriptions of the loss of motor power in muscles in nervated by specific peripheral nerves were followed by various clinical reports of "trick" movements mimicking functional regeneration. 9,17,62,63 Detailed studies of sensory loss and recovery were explained by sophisticated theo ries of collateral innervation, nerve anastomosis, or nerve growth from healthy, adjacent areas. 9,25,26,56 Findings in studies of the fascicular structure of the peripheral nerve and of histological degeneration after PNI were con firmed by the introduction of the silver precipitation stain of Golgi and the methylene blue method of Ehrlich.
18,64The monogenetic or downgrowth of nerve regeneration had been established by investigators such as G. Carl Hu ber, 29 who described the principle in simple terms:The development of military medical care for peripheral nerve injuries during World War I William Hanigan, m.D., PH.D.
Department of Neurosurgery, University of Mississippi Medical Center, Jackson, MississippiAlthough the clinical and electrical diagnoses and treatments of peripheral nerve injuries (PNIs) had been de scribed prior to World War I, many reports were fragmented and incomplete. Individual physicians' experiences were not extensive, and in 1914 the patient with a PNI remained a subject of medical curiosity, and was hardly a focus of comprehensive care.World War I altered these conditions; casualties with septic wounds and PNIs swamped the general hospitals. By 1915, specialized hospitals or wards were developed to care for neurolog...