546 OPERATIONS ON THE NERVOUS SYSTEM. 



diminution in the size of exostoses (ringbones), which we ti'eated 

 bv neurotomy ; . . . " and again, " Neurotomy, by removing the 

 jDain existing in the posterior parts of the foot, removes the cause 

 for knuckling, and prevents the retraction of the tendons ;" and 

 further, " It prevents also the serious accidents, so frequent after 

 firing of the coronet, sloughing of the skin, cartilaginous quittor, 

 necrosis of tendons or Hgaments, opening of joints, etc., all being 

 accidents likely to follow the severe cauterization which, to be suc- 

 cessful, is required in the treatment of those exostoses." 



Speaking of these advantages, Zundel says : " In rare cases, 

 besides the removal of the lameness, the recovery of the disease 

 which gave rise to it, may also be observed. Thus, after neuro- 

 tomy, contracted feet have, after a few months, regained their nor- 

 mal form, and exostoses have stopped their growth and even di- 

 minished in size." 



Having thus considered this matter, both pro and con, giving 

 on one side the objections urged against it, with the alleged facts 

 and inferences with which its oj^ponents seek to maintain their ar- 

 gument, and on the other hand, shown the reasons which influence 

 the friends of the operation in advocating and putting it in prac- 

 tice, with their statement of its utility and the important bene- 

 fits it is capable of conferring, we are prepared to examine into 

 the conditions which indicate or counter-indicate this particular 

 method of surgical interference. 



Bouley, speaking of its indications, said: "When the digital 

 region is the seat of a chronic disease, manifested by pain and 

 continued lameness, provided the alterations of structure are not 

 of such a nature as to interfere mechanically with the execution 

 of the function of the region, neurotomy is indicated." And 

 speaking of lameness, the seat of which is not located, Messrs. 

 Hardy and Hugues go farther, for with them " neurotomy can and 

 ought to be performed when a lameness from an unknown cause, 

 and whose nature is not recognized, has for a period of more 

 than three months resisted ordinary therapeutical and surgical 

 means." 



Taking these as axiomatic rules, laid down by such authorities, 

 and substantiated by the results obtained by their observance, it 

 becomes evident that in all cases of lameness of the nature de- 

 scribed by these writers, or, to repeat, lameness and pain from an 

 unknown cause, neurotomy is the indication, and if it fails to cure 



