210 
T. B. ROGERS. 
The wounds should be irrigated with water until the slight 
haemorrhage stops, then washed out with a weak creolin or bi¬ 
chloride solution, and be drawn together by a somewhat narrow r 
bandage. This, kept wet with an antiseptic, is left on until 
cicatrization takes place, unless swelling occurs above or be¬ 
neath it. 
The after care of the foot. —If possible lower the heels and 
turn the patient out for some weeks after the operation. A 
practitioner of great experience once remarked to me that he 
believed that this was almost as important as the operation, and 
I am inclined to go a good part of the way along with him. The 
foot should be soaked occasionally, and extra attention must be 
paid to its condition in hot, dry weather. 
Is the low operation advisable ? 
There is a difference of opinion on this point. My own ex¬ 
perience has been so considerable that I may keep within the 
bounds of modesty while giving an opinion. When we con¬ 
sider that the low operation always gives relief, that this relief 
is usually marked, that the operation is as nearly absolutely 
safe as an operation can be, and that in cases of partial failure 
it paves the way for a subsequent high neurotomy (for I believe 
that a low operation prepares the foot by a gradual alteration of 
nutritive conditions for the safe division of the plantar nerve), 
we must admit that a strong case has been made out for it. 
What are the usual causes of total or partial failure ? —Mis¬ 
takes in diagnosis, running horsemen often have a low neurot¬ 
omy done when the patient is suffering from concussion of the 
immature bones or sore shins. I believe that occasionally the 
tendon of the ergot is divided in mistake for the nerve (I did it 
once myself). Leaving the nerve end in the wound is a com¬ 
mon cause of failure, and this may be suspected in all cases 
where there is tenderness on pressure over the region of the 
scar, even when no clubbing of the nerve end can be demon¬ 
strated. 
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