Royle's sympathectomy for spastic paralysis: Sorry saga or scientific awakening?

Abstract

On October 20, 1924, at the Waldorf-Astoria Hotel in New York City, two medical graduates of the University of Sydney delivered the John B. Murphy Oration to the American College of Surgeons on the topic of sympathetic ramisection for the treatment of spastic paralysis. The surgery was regarded as a triumph. The triumph, however, was short-lived, when one of the speakers, John Irvine Hunter, a promising anatomist, died prematurely. Norman Royle, an orthopedic surgeon, continued the research program and continued to perform these operations. Within a few short years, however, the theory of the dual nerve supply of skeletal muscle, which underpinned the procedure, and the results of surgery for spastic paralysis came under question. Nevertheless, Royle's sympathectomy found another indication and became the treatment of choice for peripheral vascular disease for several decades thereafter. Although Hunter and Royle's original work was discredited, their research turned their sorry saga into a scientific awakening of the sympathetic nervous system.