This communication is based on a small series of 27 cases in which hypotension was induced by hexamethonium bromide, sometimes aided by procaine amide, to procure a bloodless field for fenestration. Ligation, cautery, etc., is used for the soft-tissue work and hypotension is induced only at the critical stage when the labyrinth is opened and the danger of bleeding into the fenestra exists. As soon as the flap is applied and the fenestra is sealed off, the hypotensive process is reversed. Posture is used as an important adjunct and teamwork is essential for success. The dangers of thrombosis, failure of function or damage of vital organs, and reactionary haemorrhage, must be appreciated.
The orthodox treatment-method of the infantile cerebral flaccid-spastic syndrome is briefly descriptionbed mainly in so far as kinetic therapy is concerned. The habitual concentration on eliciting immediate isolated muscle contraction is erroneous because (a) it requires good intelligence and a fair attention-span, which are rarely found in cerebral flaccid-spastic children, and because (b) in neuro-physiology such isolated muscle contractions seem to be a pure assumption. The present-day trends in neuro-muscular re-education are reviewed. They can be divided into two main groups, based on (a) the use of reflexes, and (b) evolutional ideas. Both groups accept the neuro-muscular state as they find it, and, starting from the existing primitive and reflex movements, they develop more differentiated movements. From group (a) the mirror synkinesis method and the (resisted) chain synergy method ('mass movement' method) are regarded the most important basic methods. As the former has been descriptionbed in a previous article, only the chain synergy method is expounded. It is explained through Struempell's phenomenon. It is shown that this should not be mixed up with 'confusion motion'. The great role resistance to the unaffected links of the synergy chain plays is disclosed. Resistance is also important in the synkinesis treatment and in the facilitation through tonic neck reflexes. It is stated that the (resisted) chain synergy treatment method can be used in connection with the mirror synkinesis treatment method and further faciliated by other agents. A neuro-physiological explanation of the (resisted) chain synergy treatment method is sought. Finally the importance of motivation and the consequent value of occupational therapy are stressed.