MEDIAN NEUROTOMY 171 



inflammation which may suppurate and break down en- 

 tirely. In serious navicular arthritis loss of the hoof some- 

 times occurs but this danger is not so liable to result as in 

 the high plantar operation. 



RESTRAINT. — Median neurotomy is performed in the 

 lateral recumbent position, with the affected leg undermost 

 and pulled out at an obtuse angle from the body so as to 

 plainly expose the internal level of the elbow joint. The 

 more the leg is pulled out from the body the more accessible 

 is the seat of operation. The casting harness, the casting 

 ropes, the English hopples or the operating table may be 

 used, each with good advantage. Whatever apparatus is 

 used the leg to be operated upon is released from its tie and 

 brought out at an angle of forty-five degrees from the long 

 axis of the body and there held or fastened firmly. The seat 

 of operation is anaesthetized subcutaneously with a five per 

 cent solution of cocaine hydrochlorate. General anaesthesia 

 is unnecessary, although it greatly facilitates the work of re- 

 taining the leg in the indispensable position above men- 

 tioned. The operator none too confident of his ability, or 

 the practitioner who operates only occasionally, should ad- 

 minister a general anaesthetic (chloroform) with the object 

 of securing perfect immobilization of the seat of operation. 

 In performing median neurotomy, it is found that the rela- 

 tions of the structures of the region change considerably 

 with different positions of the leg. An incision made directly 

 over the nerve with the leg in a given position may be found 

 some distance to one side or the other when the leg is drawn 

 to another position. This- fact necessitates keeping the limb 

 at a certain given point from beginning to end, which is not 

 possible if the animal struggles. This circumstance may 

 be of no importance to the experienced surgeon, but it is 

 always certain to greatly confuse the novice. When the 

 casting- harness is being used the leg is secured by first 

 fastening it at the proper angle with a stay rope extending 

 from the knee to the hopples of one of the hind legs, and 

 then looping another rope around the pastern to be held 

 forward either by passing it around a convenient post or 

 ring, or directly to the hands of one or two strong assistants. 

 The latter is preferable because if the horse changes position 

 by struggling the assistants can more easily change theirs 

 than if the rope is stayed by a post or ring. On the operat- 

 ing table, which is the most satisfactory apparatus for this 

 operation, the fixation of the leg is simple. It is released 

 from the hopple, brought forward to the proper angle and 



