NEUROTOMY. 



215 



branch. For this reason it is that, in high neurotomy, the ope- 

 ration is commonly performed above 

 the branch on the inner side of the 

 leg ; below it on the outer. 



The annexed diagram will illus- 

 trate my meaning: — Let a h, c d, 

 represent the metacarpal nerves 

 dissected out and laid upon the 

 table, connected by their commu- 

 nicating branch, e. Supposing the 

 divisions of the two nerves made at 

 any points represented by o o, it is 

 evident communication with the 

 sensorium would still be carried on 

 through the communicating branch; 

 whereas, were such points as are 

 represented by L P orp Z, chosen for 

 section, the communicating branch 

 would no longer serve the purpose p 

 of concatenation, because the divi- 

 sions proved either both above or 

 both below the points of communi- 

 cation. ^ ^ 



Improvements in Neurotomy, since its first introduction, 

 have been suggested, and some of them have turned out of merit 

 enough to be carried into practice. The chief objects in view in 

 the performance of such an operation are expertness and neatness. 

 While no cutting or meddling should be spared which can any- 

 wise conduce to the efficiency of the operation, it is at all times 

 an object, and one deserving consideration, to leave as little 

 wound or blemish as possible consequent on it. This consideration 

 has prompted the substitution for the ordinary operation of what 

 may be called 



Subcutaneous Neurotomy ; the operation surgeons are in 

 the habit of resorting to when nerves are to be divided for the 

 relief of tic doloureux or other painful affections ; a long, straight, 

 narrow, sharp-pointed bistoury being the instrument commonly 



