Abstract Since the work of Royle and that of Hunter1 on the relation between the sympathetic nervous system and spastic paralysis, it has become obvious that a striking and persistent increase in blood flow follows interruption of sympathetic pathways to the extremities. Although previous attempts to increase peripheral blood flow by periarterial sympathectomy2 had been followed by transient improvement, lumbar ramisectomy as practiced by Royle3 and by Hunter1 resulted in a more prolonged effect. This observation was the stimulus for extensive study of the relation between the sympathetic nervous system and the peripheral circulation. During the past fifteen years much has been learned about the anatomy and physiology of the sympathetic nervous system.4 Clinical application of this knowledge to the treatment of various peripheral vascular disorders now appears to be well established. FUNDAMENTAL PRINCIPLES Out of the tremendous amount of clinical and experimental evidence collected in References 1. Hunter, J. I.: The Influence of the Sympathetic Nervous System in the Genesis of the Rigidity of Striated Muscle in Spastic Paralysis , Surg., Gynec. & Obst. 39:721, 1924. 2. Leriche, R.: De l'élongation et de la section des nerfs périvasculaires dans certains syndromes douloureux d'origine artérielle et dans quelques troubles trophiques , Lyon chir. 10:378, 1913. 3. Royle, N. D.: A New Operative Procedure in the Treatment of Spastic Paralysis and Its Experimental Basis , M. J. Australia 1:77, 1924. 4. White, J. C.: The Autonomic Nervous System , New York, The Macmillan Company, 1935. 5. Gask, G. E., and Ross, J. P.: The Surgery of the Sympathetic Nervous System , Baltimore, William Wood & Company, 1934. 6. Livingston, W. K.: The Clinical Aspects of Visceral Neurology , Springfield, Ill., Charles C. Thomas, Publisher, 1935. 7. (a) Elliott, T. R.: The Action of Adrenaline , J. Physiol. 32:401, 1905. 8. (b) Cannon, W. B., and Uridil, J. E.: Studies on the Conditions of Activity in Endocrine Glands: VIII. Some Effects on the Denervated Heart of Stimulating the Nerves of the Liver , Am. J. Physiol. 58:353, 1921. 9. (c) Cannon, W. B., and Rosenblueth, A.: Studies on Conditions of Activity in Endocrine Organs: XXIX. Sympathin E and Sympathin I , Am. J. Physiol. 104:557, 1933. 10. (d) Freeman, N. E.; Smithwick, R. H., and White, J. C.: Adrenal Secretion in Man: The Reactions of the Blood Vessels of the Human Extremity, Sensitized by Sympathectomy to Adrenalin and to Adrenal Secretion Resulting from Insulin Hypoglycemia , Am. J. Physiol. 107:529, 1934. 11. (e) Smithwick, R. H.; Freeman, N. E., and White, J. C.: Effect of Epinephrine on the Sympathectomized Human Extremity: An Additional Cause of Failure of Operations for Raynaud's Disease , Arch. Surg. 29:759 ( (Nov.) ) 1934. 12. (f) Ascroft, P. B.: The Basis of Treatment of Vasospastic States of the Extremities: An Experimental Analysis in Monkeys , Brit. J. Surg. 24:787, 1937. 13. Lewis, T., and Pickering, G. W.: Vasodilatation in the Limbs in Response to Warming the Body, with Evidence for Sympathetic Vasodilator Nerves in Man , Heart 16:33, 1931. 14. Gibbon, J. H., Jr., and Landis, E. M.: Vasodilatation in the Lower Extremities in Response to Immersing the Forearms in Warm Water , J. Clin. Investigation 11:1019, 1932. 15. Brown, G. E.: The Treatment of Peripheral Vascular Disturbances of the Extremities , J. A. M. A. 87:379 ( (Aug. 7) ) 1926. 16. Allen, A. W., and Smithwick, R. H.: Use of Foreign Protein in the Treatment of Peripheral Vascular Diseases: Results of Intravenous Injections of Typhoid Vaccine , J. A. M. A. 91:1161 ( (Oct. 20) ) 1928. 17. White, J. C.: Diagnostic Blocking of Sympathetic Nerves to Extremities with Procaine , J. A. M. A. 94:1382 ( (May 3) ) 1930 18. Diagnostic Novocaine Block of the Sensory and Sympathetic Nerves: A Method of Estimating the Results Which Can Be Obtained by Their Permanent Interruption , Am. J. Surg. 9:264, 1930. 19. Morton, J. J., and Scott, W. J. M.: Methods for Estimating the Degree of Sympathetic Vasoconstriction in Peripheral Vascular Disease , New England J. Med. 204:955, 1931. 20. Bolton, B.; Carmichael, E. A., and Stürup, G.: Vasoconstriction Following Deep Inspiration , J. Physiol. 86:83, 1936. 21. Kegerreis, R.: Calometric Studies of the Extremities: II. Experimental Apparatus and Procedures , J. Clin. Investigation 3:357, 1927. 22. Freeman, N. E.: The Effect of Temperature on the Rate of Blood Flow in the Normal and in the Sympathectomized Hand , Am. J. Physiol. 113:384, 1935. 23. Hertzman, A. B.: Photoelectric Plethysmography of Fingers and Toes in Man , Proc. Soc. Exper. Biol. & Med. 37:529-534, 1937 24. Comparative Estimation of Blood Supply of Skin Areas from Photoelectrically Recorded Volume Pulse , Hertzman Proc. Soc. Exper. Biol. & Med. 38:562-564, 1938. 25. Finesinger, J. E.; Hensner, A. P., and Smithwick, R. H.: Vasomotor Studies in Raynaud's Disease Before and After Sympathectomy , Tr. Am. Neurol. A. 65:193, 1939. 26. Landis, C.: Electrical Phenomena of the Skin (Galvanic Skin Response) , Psychol. Bull. 29:693, 1932. 27. Finesinger, J. E.: Unpublished data. 28. Darrow, C. W.: The Galvanic Skin Reflex, not a Vasoconstrictor Phenomenon , Psychol. Bull. 26:155, 1929. 29. Govaerts, J.: Contribution à l'étude de l'innervation sympathique du coeur , Arch. internat, de méd. expér. 11:629, 1936. 30. Tower, S. S., and Richter, C. P.: Injury and Repair Within the Sympathetic Nervous System: III. Evidence of Activity of Postganglionic Sympathetic Neurons Independent of the Central Nervous System , Arch. Neurol. & Psychiat. 28:1149 ( (Nov.) ) 1932. 31. Simeone, F. A.: The Effect of Regeneration of the Nerve Supply on the Sensitivity of the Denervated Nictitating Membrane to Adrenine , Am. J. Physiol. 120:466, 1937. 32. Richter, C. P.: The Nervous Control of the Electrical Resistance of the Skin , Bull. Johns Hopkins Hosp. 45:56, 1929. 33. Richter, C. P.: A Study of the Electrical Skin Resistance and the Psychogalvanic Reflex in a Case of Uni-Lateral Sweating , Brain 50:216, 1927. 34. Solomon, P.: The Psychogalvanic Reflex: Applications to Neurology and Psychiatry , Arch. Neurol. & Psychiat. 34:818 ( (Oct.) ) 1935. 35. Simmons, H. T., and Sheehan, D.: An Inquiry into "Relapse" Following Sympathectomy , Lancet 2:788, 1937. 36. Smithwick, R. H.: Modified Dorsal Sympathectomy for Vascular Spasm (Raynaud's Disease) of the Upper Extremity: Preliminary Report , Ann. Surg. 104:339, 1936 37. The Value of Sympathectomy in the Treatment of Vascular Disease , New England J. Med. 216:141, 1937 38. The Sympathetic Nervous System and Vascular Disease , in Blumer, G.: The Practitioner's Library of Medicine and Surgery , New York, D. Appleton-Century Company, Inc., 1938, vol. 13 39. The Rationale and Technique of Sympathectomy for the Relief of Vascular Spasm of the Extremities, New England J. Med., to be published. 40. Smitliwick, R. H., and White, J. C.: Peripheral Nerve Block in Obliterative Vascular Disease of the Lower Extremity , Surg., Gynec. & Obst. 60:1106, 1935.
Archives of Surgery – American Medical Association
Published: Feb 1, 1940
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