PRINCIPLES UNDERLYING THE OPERATIVE TREATMENT OF STRABISMUS

It seems profitable to discuss here chiefly principles that are but partly recognized, forgotten or ignored, rather than those regarding which there is full recognition and agreement. We never forget that the normal contraction of a muscle brings its origin and insertion closer together. But it often seems to be forgotten that such normal contraction does not arise in the muscle itself, but is absolutely dependent on the nerve impulses coming to the muscle from the motor centers. Functionally the muscle has no existence apart from the nerve supply. Even its anatomic integrity depends on receiving the proper nerve impulses. If these are cut off permanently the muscle atrophies completely. If they are seriously interfered with degenerative changes set in. If they are diminished the muscle shrinks; if they are increased it hypertrophies. No operative readjustment of the ocular muscles can be permanent that is opposed by these nerve impulses;