NEUROTOMY 133 



form within the incisions. They are prevented by aseptic 

 methods of operation, careful stitching, stretching the nerve 

 before dividing and keeping the patient quiet during the week 

 following the operation. When the sensitiveness persists, 

 total ablation of the -scar and a portion of the nerve trunk 

 above it may be necessary to relieve the lameness. 



4. Neuromas. — The neuromas following neurotomy 

 operations appear in the form of small pea-like nodules at- 

 tached to the proximal cut end. When they follow in the 

 wake of a well healed incision they are found to be movable 

 and not attached to the skin, while in the badly healed in- 

 cision they are naught but the sensitive scar previously men- 

 tioned. They are not true tumors as the name given them 

 would indicate, but the result of a futile effort to re-establish 

 communication with the distal cut end. They are analogues 

 of the amputation neuroma of human surgery. , They consist 

 of new-formed neurolemma infiltrated with axones vainly at- 

 tempting to grow, but which become lost in the more rapidly 

 formed connective tissue. As to special cause the neuroma 

 is an enigma. They appear as sequelae of any technique that 

 may be tried to prevent them. As in the case of the sensi- 

 tive scar the lameness they provoke may demand their 

 ablation. Hughes recommends stretching of the nerve so as 

 to bring a considerable length out of the wound before cutting 

 it off, claiming that the cut end will then recede some distance 

 above the wound, out of the reach of influences which would 

 tend to promote regenerative activity. The stretching prob- 

 ably causes an ascending degeneration. They can always 

 be prevented to a certainty by pulling tliQ, nerve out bodily 

 instead of cutting it off, but this method is very painful and 

 often causes a very intense pain in the legs for some days 

 after the operation. 



5. Failure to Cure the Lameness. — Neurotomy may fail 

 to cure lameness from various causes, but more often it is 

 due to error in the diagnosis. Sometimes the diseased 

 process is rather too wide-spread to admit of unnerving, and 

 at other times the motion of a joint is mechanically ob- 

 structed and this prevents any possible amelioration of the 

 lameness. 



6. Fracture of the navicular bone sometimes constitutes 

 the injury sustained in breakdown, and the accident indicates 

 that the bone had undergone a too serious structural dis- 

 integration to perform its weight-bearing function. 



6. Haemorrhage. — The haemorrhage that occurs during 

 the ordinary neurotomy although troublesome, is always 



