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SURGICAL INTERVENTION ON THE SYMPATHETIC NERVOUS SYSTEM FOR PERIPHERAL VASCULAR DISEASE

R. H. SMITHWICK, M.D.
Arch Surg. 1940;40(2):286-306. doi:10.1001/archsurg.1940.04240010126009.
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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

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