NEUROTOMY OF THE MEDIAN NERVE. 141 



nective tissue sheath down on to the nerve, laying it bare. 

 The borders of the cutaneous wound are held apart with 

 tenacula and by palpation with the fingers or by vision it is 

 determined if the nerve lies in the middle of the wound. If 

 necessary continue the dissection with the scalpel until the 

 nerve is clearly revealed ; it is distinguished by its faintly 

 yellowish color, its fine longitudinal striae and its location 

 behind the metacarpal artery. Immediately above the fet- 

 lock joint the median metacarpal or metatarsal nerve divides 

 into an anterior smaller, d, and posterior larger, o, branch. 

 This division should be laid bare in order that the operator 

 may not erroneously cut one branch only. Immediately 

 above this point of division the aneurism needle is passed 

 under the nerve, then a second needle is inserted beside it 

 and the two pulled apart separating the nerve from the ad- 

 jacent tissues, the scissors or a small probe-pointed bistoury 

 is passed beneath and it is cut through quickly at the superior 

 angle of the wound. The distal end of the nerve is then 

 dissected free as far as possible downward and both brandies 

 excised at the lower angle of the wound so that a section 

 3 to 5 cm. long is removed. The cutaneous wound is united 

 by a continuous suture and a temporary bandage applied. 

 The extension splint, if it has been used, is then removed, 

 the foot replaced in the hobble and the horse turned to the 

 other side. Neurotomy of the opposite metacarpal nerve is 

 carried out in the same way after which a sterile bandage is 

 applied and allowed to remain eight days. Healing by 

 primary union. 



37. NEUROTOMY OF THE MEDIAN NERVE. 

 PI.ATE XXII. 



Objects. The relief of lameness due to disease so located 

 in the anterior limb that it cannot be overcome by plantar 

 neurotomy. 



