NEUROTOMY 135 



partially to the exhilarating influence of the cocaine, which 

 at this stage is becoming evident, and at other times it is 

 due to the combined influence of the cocaine and the un- 

 comfortable duration of the procedure. Aside from the co- 

 caine exhilaration, which is very frequently noticed, the ter- 

 rible agony of dividing two or three partially cocainized large 

 trunks consecutively, will often provoke a state of frenzy in 

 the most complacent horse. Standing neurotomy as it is 

 vulgarly called is acceptable only in the unilateral case. For 

 the bilateral case it is much less satisfactory in the great ma- 

 jority of cases. The practitioner may also be guided by other 

 circumstances ; scarcity of help, unskilled help, lack of a suit- 

 able place for casting, extreme age of the subject, etc. 



The recumbent position gives a much better opportunity 

 to thoroughly disinfect the field, to perform a neat and clean 

 dissection and to approximate the edges of the incision, than 

 the standing position. The operating table is par excellence 

 the best restraint, every thing considered. Aseptic opera- 

 tions are easily performed in the position attained upon the 

 table. In the ropes there are always more dangers of soiling 

 the wound, hands and instruments from the close proximity 

 of the field to the litter upon which the horse is cast. This 

 adverse element is eliminated entirely with the table. Fur- 

 thermore the parts are much better immobilized than with 

 the ropes; however, the latter can be utilized to very good 

 advantage when the table is not available. The horse is cast 

 in the usual manner and the affected leg released- and fixed in 

 the extended position, where it is held by strong assistants. 

 The use of a small amount of cocaine at the seat of operation 

 will still farther facilitate matters. When one side is finished 

 the horse is rolled over for operation on the opposite side of 

 the leg or for the opposite leg as the case may be. On the 

 table the bilateral operations are somewhat prolonged be- 

 cause of the necessity of casting the horse twice to expose 

 the surgical fields, but this disadvantage is one of speed only. 



The standing position as before stated, is specially com- 

 mendable for unilateral operations. Only the plantars and 

 digitals can be properly divided in this position. A tourni- 

 quet is applied to the shin, the seat shaved and disinfected, 

 the- twitch applied, the field anaesthetized by subcutaneous 

 injections of cocaine, and the leg held up into a comfortable 

 position for operation by an assistant. In addition to the 

 cocaine the shaved surface may be still further anaesthetized 

 by spraying with ethyl chloride. When the nerve has been 

 exposed cocaine solution may be applied directly to it on a 



