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Evidence of varied nature indicates that the arterioles of the splanchnic region are constricted in patients suffering from essential hypertension, and that this may be an important factor in maintaining the pressure at an elevated level. Interruption, by surgical means, of nerves carrying effector impulses to this region would therefore appear to be a logical therapeutic procedure.Section of the anterior nerve roots close to the cord seems a method which will surely intercept both the motor and sympathetic innervation. It is furthermore desirable that denervation be as complete as possible without interfering with vital functions. Anatomical considerations suggest that this can best be accomplished by section of the anterior roots from the sixth thoracic segment to, and including, the second lumbar.The sixth to the twelfth thoracic motor nerves innervate the intercostal muscles and the seventh to first lumbar nerves supply the abdominal musculature. Part of the supply to the flexor muscles of the hip is derived from the first and second lumbar nerves. The first lumbar root contributes branches to the ileoinguinal and ileohypogastric nerves, and both the first and second roots send fibers to the genito-femoral. The lateral cutaneous nerves receive fibers from the first, second and third lumbar roots.There is some difference of opinion as to the anatomy of the sympathetic system in the thoracico-lumbar region. All of the anterior nerve roots contribute to the innervation of the cutaneous vessels, pilomotor muscles and sweat glands. The major splanchnic nerves are derived from the fifth to the tenth thoracic segment, and the minor splanchnic from the ninth and tenth or the tenth to twelfth roots. These nerves join the celiac plexus. In this manner connection is established with the stomach, liver, adrenals, pancreas, intestine and kidneys. Section of the sixth thoracic to the second lumbar roots, therefore, partially interrupts not only the motor nerve supply of the abdominal wall but the sympathetic supply of most of the abdominal viscera, except the colon, rectum, bladder and genital organs. The vagus and phrenic nerves and the intrinsic nerve supply remain intact to innervate the viscera. The inferior mesenteric ganglion also remains intact except for loss of some fibers from the second lumbar root.Adson and Brown (1) (1934) were the first to suggest and perform the operation as outlined.By this procedure they hoped (1) to remove the sympathetic innervation of sufficient arteries to modify arterial responses, (2) thoroughly to denervate the suprarenal glands, and (3) to remove the effects of intra-abdominal tension. They report a case of early malignant hypertension in a woman 29 years of age who had had high blood pressure for at least 18 months. The blood pressure in the recumbent position varied from 150 to 200 systolic and from 100 to 150 diastolic. The range following operation was from 155 to 195 systolic and from 100 to 150 diastolic. After operation no visible sweating was found below the level of the e...

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Jaboulay(1) appears to have been the first to perform the operation of periarterial neurectomy in man. The procedure, however, did not achieve popularity until after the appearance of a series of papers by Leriche and his associates (2, 3). The effect on patients suffering from peripheral vascular disease has been especially extensively investigated. Denervation of the kidneys more recently has been performed on patients suffering from nephralgia and hydronephrosis, success being achieved in the relief of pain. ANATO M ICALThe renal nervre supply is derived mainly from the celiac ganglia with small branches from the plexuses around the adrenal gland and the aorta.Usually one branch comes from the splanchnic nerves direct. Through the celiac ganglion the renal nerves are brought into connection with the splanchnic nerves and with the vagus. The vagus nerve also sometimes-sends a direct branch to the kidneys. A few branches are received from the superior mesenteric ganglion.It has long been recognized that the splanchnic nerves form the chief vasomotor supply of the kidneys. Bradford (4) found that stimulation of the anterior roots of the cord from the sixth thoracic to the second lumbar segment caused the kidneys to constrict. Of these roots the tenth to twelfth dorsal were most effective. Vasodilator fibers were also present but were weak in comparison with the constrictors.Langley and Anderson (5), Jost (6), and Hirt (7) have clearly demonstrated fibers coursing from the third, fourth, and fifth lumbar ganglia to join the renal plexus. Most of the nerves are non-medullated, but some in the plexus are myelinated (Renner (8)). Ganglion cells which are

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