178 
NEUROTOMY. 
manner, and let the limb to be operated on be separated and held 
in a side-line, until it can be brought to be bound down upon a truss 
of hay, previously covered with a linen cloth, to serve as a sort of 
operating table. And, in order to afford still greater security and 
steadiness of the limb so placed daring the operation, an assistant, 
holding a blunt iron hook passed underneath the toe of the shoe, 
may firmly stay the foot, and keep the limb extended. While 
this is being done, however, it requires some vigilance on the part 
of the operator to see that the limb is not drawn into such a false 
position by over-extension, that, when the incisions come to be 
made, and the limb in the interim comes to change position, he 
finds the cut in the skin not opposite, as he expected, to the parts 
he is seeking for, but to one side of them ; the consequence of 
which will be, to embarrass him more or less in his future proceed- 
ings. Therefore, on having the limb placed in position, let the 
operator take care that no such deviations by dragging or stretch- 
ing be made as will throw parts in respect to the skin covering 
them out of their natural positions. Formerly, the part to be cut 
into used to be shorn of its hair prior to casting. This however is 
nowadays, perhaps wisely, dispensed with ; the hair not being 
much in one’s way, and the blemish being, for a time, the greater 
after the wound is healed. 
Prior to commencing the Operation, it will perhaps be as 
well for the operator to run over in his mind the course and rela- 
tive situation of the parts about to engage his attention. He will 
remember that 
The Metacarpal Nerves are double, one running down either 
side of the leg ; while the metacarpal artery is single, and accom- 
panies the nerve on the inner side. This renders the relative 
course of one nerve different somewhat from that of the other. 
The internal Metacarpal Nerve, descending below the 
knee, lies buried underneath a faschia spreading from the knee 
upon the flexor tendons, wherefrom it is stretched across to the can- 
non bone, ending below in a crescentic border, underneath which, 
as under an arch-way, nerve, artery, and vein, are all seen 
emerging in their course down the leg. In the first part of its 
course the nerve runs close behind the artery, the vein being in 
front, a relative position which it (the vein) maintains throughout 
its subsequent course to the foot. About one-third of the length 
of the cannon downwards, the nerve detaches the communicating 
branchy so called from its uniting with the nerve on the outer side, 
which it does, after obliquely crawling round the back of the flexor 
tendons, at about the distance (measured in a straight line) of two 
inches and a half below its place of origin. After sending off this 
branch, the trunk more inclines in its passage downwards from the 
