M. DUPUY ON THE OPERATION OF NEUROTOMY. 57 
ends of the nerve and the re-establishment ol its action. It this 
point were once cleared up, our ideas would acquire the force 
of demonstration; nevertheless, that which has been proved as 
to individual cases is sufficiently so as it regards the principle 
of the thing; and a sufficient number of eminent surgeons have 
carefully studied the phenomena relating to the divided ends ol 
nerves to enable us to appreciate the results, and apply them to 
the subject which now occupies us. We solicit attention and 
careful observation of our readers to this subject ol such high 
interest. 
Let us pass now to another point, and see if the operation of 
neurotomy has always been performed as it ought to be. We 
have reasoned on supposition that both the nerves have been cut 
at the same time, and indeed it is thus that the greater part of 
the authors who have written on neurotomy have operated; 
nevertheless, is it rational to cut equally both the nerves of the 
foot, whether the disease of this region be general, or whether 
it occupies only a part? Without doubt, no; and if this pro¬ 
ceeding is good in the first case, it is obviously bad and illogical 
in the second, where the disease, occupying a circumscribed 
point, permits us to obtain, by the section of a single branch of 
the nerve which goes to this point, an effect more advantageous 
than that which is procured by the cutting of the two plantar 
branches. The manner of performing the operation of neu¬ 
rotomy cannot then alw T ays be the same, and ought to vary 
with the seat of the disease; we may, nevertheless, otter cer¬ 
tain modifications, according as we cut the two plantar nerves 
or only one, the external or the internal, above the fetlock; or 
whether the operation is made under the fetlock on an anterior 
or a posterior branch; or whether only an anterior or posterior 
branch is divided on each side, or both the anterior, or both the 
posterior ones. But to apply these principles,—that which is 
absolutely essential is to determine exactly the seat of those 
diseases which require neurotomy, and not to make this opera¬ 
tion an exclusive means against one kind of lesion only. Most 
authors, it is true, have avoided this fault: Goodwin, for ex¬ 
ample, tells us positively to have recourse to neurotomy for 
cases that bid defiance to all other means. But in general it is 
an error more frequent, that neurotomy is only useful in rare 
and uncommon cases; thus, in the navicular disease, which, by 
a singular chance, seems never to have shewn itself but to the 
authors wh have described it, or rather in cases of occu It lame¬ 
ness, that is to say, in cases where, being able to trace the evil 
to no particular part, we fancy it to be every where. 
For ourselves, guided by the opinions which we have here 
VOL. IV. i 
