PLANTAR NEURECTOMY. 9 1 



connective tissue, bones, and articulations ; and if, up to the present, 

 their pathology is incompletely understood, it is known that mechanical 

 violence does not appear necessary for their production. 



It has been shown that after section of nerves the specialised cells 

 of the peripheral end undergo retrogressive changes eliding in destruc- 

 tion, and that regeneration occurs by a kind of branching of the fibres 

 of the central end. This reconstitution of nerves explains the occasional 

 return of lameness after operation, and the removal of this secondary 

 lameness when neurectomy is again performed above the point first 

 selected, Stanley related a case of this kind. Two years after the 

 first treatment the horse went lame and he again operated, this time 

 above the cicatrices left by the former intervention. As in the first 

 instance, the animal became sound. 



But this regeneration, which occurs when only a short portion of 

 the nerve has been removed, is always somewhat imperfect. The 

 permanent good effects of neurectomy, and the delayed complications 

 which it sometimes produces, are both referable to this incomplete 

 regrowth. This view, better than any other, explains the lasting good 

 effects of neurectomy. Success is due to the fact that sensation only 

 returns to a modified extent in the tissues from which it has temporarily 

 been removed. The pathogeny of the after complications, trophic or 

 otherwise, is governed by the same cause. 



I conclude by reminding you that, on the whole, grave complica- 

 tions after neurectomy are not frequent, and that even taking them into 

 account, the practical value of the operation remains indisputable. 

 Plantar neurectomy has too often given good results to be condemned. 

 Undoubtedly it is only a kind oi ultima ratio, but before abandoning a 

 case of lameness which has improved but little or not at all under other 

 treatment this last resource should certainly be tried. 



