BY,

C. PELLERIN,

LATE REPETITOR OF CLINIC AND SURGERY TO THE

ALFORT VETERINARY SCHOOL.
TRANSLATED, WItH ADDITIONAL Facts RELATING TO IT.
BY

PromoA. LIAUTARD, M. D., V. M.

New YORK :
WILLIAM R. JENKINS,
VETERINARY PUBLISHER AND BOOKSELLER,

851-853 SIxTH AVENUE,
1896.

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MEDIAN NEUROTOMY

IN THE TREATMENT OF

CHRONIC TENDINITIS AND PERIOSTOSIS OF THE FETLOCK

BY

y
C. PELLERIN,

LATE REPETITOR OF CLINIC AND SURGERY TO THE

ALFORT VETERINARY SCHOOL.
TRANSLATED, WITH ADDITIONAL Facts RELATING TO IT,
BY

Prom A, LIAUTARD.. MD: Vv. Me

New York:

WILLIAM R. JENKINS,
VETERINARY PUBLISHER AND BOOKSELLER,
851-853 SixTH AVENUE.

1896,

&
Copyright, 1896, By WiILLIAM R. JENKINS.
All Rights Reserved.

PRINTED BY THE
Press OF WILLIAM R. JENKINS,
New York.

INTRODUCTION,

On the 25th of June, 1892, when I was adjunct to the
Chair of Clinic and Surgery in the Alfort Veterinary School,
I successfully performed upon a mare suffering with chronic
tendinitis, the section of the median or cubito-plantar nerve.

This special neurotomy had already been performed in
Germany and in Belgium, but this was the first time in
France.

I have used it a great number of times since, and have
always obtained good results against that disease. It can also
be advantageously applied in periostosis of the fetlock.

To actual cauterization, recommended for those affec-
tions, with which the surgeon was almost entirely powerless,
and at best giving only a temporary relief, median neurotomy
is called to render enormous services.

When one thinks of the great number of animals which,
otherwise doomed to destruction, through it will almost at
once become of much greater value than before, and useful
for several years-longer, one is astonished at the advantages
that the operation will bring to all trades and industries
employing the horse as a motor.

Agriculture, so much neglected of late, but which, not-
withstanding, has remained one of the principal sources of
wealth for the country, will also be benefited in a double
way. First, this operation will benefit it through the general

lv INTRODUCTION

gains already mentioned; but, again, it will be possible,
at little expense, to obtain, in the large cities, horses which,
free from lameness, could be advantageously disposed of in
spite of their blemishes. These animals in the fields will
render as good serviec as others of a higher price, while
the latter, for the benefit of the cultivator, will take the place
of the former.

As there are no little savings through economies, either
commercial, industrial, and especially rural, this operation
must be welcome.

I have already presented two communications concerning
it to the Société Centrale de Médecine Vétérinaire. To-day, I
believe it is sufficiently known to make of it a general study.

This, therefore, I submit to the judgment of the veterinary
world, and shall be most happy if it prove useful.

The work is divided into two parts: The first covers the
study of median neurotomy itself; the second, the exact
relations of the facts as I have observed them.

C. PELLERIN.

Paris, 10th January, 1895,

_

PART FIRST.

MEDIAN NEUROTOMY, or MESONEURECTOMY

Definition.

consists in dividing the median or cubito-plantar nerve and in

Median neurotomy is an operation which

excising two or three centimetres of the peripherical end.

Denomination.—Foreign authors, who before me have
studied the section of the median, having given no name to
that operation, I myself have filled the omission.

I have called it “Median Neurotomy” because it is per-
formed on that nerve. This name is simple, besides it is
short, and gives an exact idea of the surgical action, as it
contains the name of the operation and that of the organ upon
which it is performed; these three essential qualities made me
adopt it. It is preferable to that of radial neurotomy, which
indicates immediately that it is performed in the radial region ;
but this could induce error, as there is a radial nerve upon
which the operation is not performed.

Cubito-plantar neurotomy would have been a rather long
“name, and anti-brachial neurotomy does not indicate upon what
nerve the resection is made.

It is also possible to designate median neurotomy by a
compound word. The term medianotomy (medianus, middle,
Tom), section), used somewhat carelessly by Ries, should not
be kept in use, as it is formed of a Latin and a Greek root,
and does not indicate that it means a neurotomy. Mesonevro-

6 MEDIAN NEUROTOMY

tomy (MéooS middle, vevpov nerve, Ton section), might be
used, or else mesoneurotomy, which has the same roots but is
more regular. Again, it is better to use meso-neurectomy
(uéoo€ middle, vedporv nerve, éytopn excision), or, still better,
mesoneurectomy, which has the same roots and is more regular.
These two last names indicate that excision is meant.

Generally, one ought to say nevrectomy, and not nevrotomy,
which, if it were not for the habit of the use of the term,
would indicate a section, and not a partial excision,

I have selected the word mesonewrectomy, but placed it
only in second line, as I am afraid it will be accepted with difli-
culty in general practice ; however, I will often use it in the
course of this subject.

History.

The history of median neurotomy is short.

Peters (1), instructor in the Berlin Veterinary School, is, as’

far as I know, the first who performed it. On the 2d of
December, 1885, he presented to the Society of the Veterinary
Practitioners of Berlin a long and interesting paper upon
“Neurotomy in Cases of Chronic Lameness of the Horse’s
Legs.” After severely criticizing, in the first part, plantar
neurotomies, and specially the high operation, he gave, in the
second part, the relations of several neurotomies performed
upon the median, naming the diseases against which he had
employed it, and giving the modus operandi he used, with the
results he had obtained.

Ries (2), professor at Ettelbruck (Luxemburg), in an
article entitled, “A Veterinary Excursion in Belgium,” says:
“Upon a young saddle horse, I was able to see the very serious
accidents resulting from this fancy neurotomy which is per-
formed upon the median beyond the Rhine. Consecutively to

(1) J. Peters: ‘‘ Wochenschrift fiir Thierheilkunde und Wichzucht
von Adam.” 1886. pp, 190 and 201.

(2) Ries: ‘‘ Recueil de Méd. Vét,”’ 15th May, 1890, p. 312,

MEDIAN NEUROTOMY v

the operation performed against navicular disease (or sub-
acute podotrochilitis), appeared a laminitis, which assumed the
chronic form and was followed by perforation of the dropped
sole. Kverything justifies me in believing that medianotomy
has had its day at Cureghem. It is proper at this time to
ask the following question: Is gangrene, as an accident subse-
quent to neurotomy, the termination of a more or less severe
laminitis, or is chronic laminitis a special complication of the
section of the median nerve ?”

Hendrickx (1), adjunct of surgery in the Cureghem School,
says, at the end of an article upon ‘The Late Accidents
Following Plantar Neurotomy ”: “ Lately a German author has
recommended the section of the median nerve in the anti-
brachial region; he claimed that the ordinary accidents did
not appear after the operation. We acknowledge not to
understand the effect that the section of the median nerve
could have to prevent serious complications. The application
which has been made of this process in the clinic of the
Cureghem school is not of a nature to give me great confidence
in the efficacy of this operation. Here two horses were
operated upon, and on one of them we saw, after five or
six weeks, serious troubles of the foot and tendons, which
rapidly assumed such a character that the animal had to be
killed.”

I have taken care in reproducing literally these two
authors, who evidently speak of the same horse, banishing as
they do in an absolute manner mesoneurectomy.

Ellenberger (2) quotes a work of Goldmann, published
in the “ Zeitschrift fiir Veterindirkunde mit besonderer Beriicksich-
tigung der Hygiene, Organ fiir Rossiirzte der Armee,’ 3d year,
p. 249), upon the ‘“‘Neurotomy of the Median Nerve.” I was

(1) Hendrickx : ‘‘ Annales de Méd. Vét.” Nov., 1890. p. 586.
(2) Ellenberger: ‘‘ Jahresbéricht tiber die Leistungen auf dem Gebiete
der Veterinar-Medicin,” year 1891, p. 145,

8 MEDIAN NEUROTOMY

‘unable to obtain this journal, and therefore could not consult
the article of Goldmann. However, the analysis made of it by
Ellenberger contains very interesting data upon the modus
operandi and the results obtained.

On the 8th of December, 1892, at a meeting of the Société
Centrale de Médecine Vétérinaire, Moussu, professor at
Alfort, presented in my name (1) a paper relating to a case
upon “ Nevrotomy performed upon the median nerve or the
cubito plantar,” and also another one on the study of ‘‘ Median
Nevrotomy or Mesoneurectomy.” In the latter I considered
all the questions relating to the operation, indications, anatomy
of region, modus operandi, results, ete.

At the beginning of the year 1894, Angelo Baldoni (2), of
the Milan school, published a pamphlet upon “‘The Median
Nevrectomy of the Horse,’ which he kindly sent me, end in
which I have the honor of being quoted several times.

I saw in that pamphlet that Kull (3), a German veterin-
arian, had in 1893 performed with good results the section of
the median upon a horse that suffered with ringbones (formes)
and a disease of the foot not named.

The work of Baldoni contains new and even original ideas,
but too theoretical and almost imaginary, upon the indica-
tions, the effects of the operation, and the place to perform it. |

In April, 1894, at the Société Centrale, Moussu again pre-
sented in my name (4) another article, entitled “De la
névrotomie médiane ou mésoneurectomie employée contre

la nerf-férure” (Median neurotomy or mesoneurectomy em-

(1) Pellerin: ‘“‘ Névrotomie pratiquée sur le nerf médian ou cubito-
plantaire.—De la névrotomie médiane ou mésoneurectomie.” (Bul. Soc.
Cent. Méd. Vét. 1892. p. 746.)

(2) Angelo Baldoni: ‘‘La nevrectomia del mediano nel cavallo.”
Milan, 1894.

(3) Kull: ‘Zeitschrift fir Veterinarkunde,” 1893, p. 14.

(4) Pellerin: ‘‘De la névrotomie médiane ou mésoneurectomie
employée contre la nerf-ferure.” (Bull. Soc. cent. 1895, p. 268.)

MEDIAN NEUROTOMY 9

ployed against chronic tendinitis), in which I related new
eases that I had observed.

Bossi, of Pisa (1), in October, 1894, published a small
pamphlet, which he sent me: ‘‘ Recherches sur la névrectomie
du nerf médian chez le cheval” (Researches upon the nevrec-
tomy of the median nerve in the horse).

This author used the operation therapeutically only once.
The object of his work was to specially make researches ex-
perimentally upon the new ideas advanced by Baldoni, which
I had criticized in my second communication, and see if they
were correct.

This is all I know of the history of median neurotomy.
Perhaps other facts have been published by foreign veter-
inarians; but the difficulty inherent in bibliographical
researches in foreign languages have prevented me from
finding them, and will be sufficient excuse for possible but
involuntary omissions.

One may have remarked that in this historical resume,
except for Ries and Hendrickx, whose very short notices I
have quoted im extenso, I have only mentioned the authors
without discussing them; this is because I believe it more
rational to comment on them in the course of the description
of the operation.

Indications.—Peters has used the section of the median
with good results against navicular disease, ringbones and
chronic tendinitis; but he has not stated whether he operated
above or below the branch that this nerve sends posteriorly,
on a level with the articulation of the elbow, to the internal
flexor of the metacarpus and to the flexors of the phalanges.
(Fig. 2, 3, 4 and 5, N’ N”.)

As seen by his own indications, he concludes to substitute

(1) Bossi: ‘‘ Ricerche sulla nevrectomie del mediano degli equini.”
Pisa, 1894.

10 MEDIAN NEUhOTOMY

median for plantar neurotomies. The advantages which he
finds in the first are that it does not destroy the sensibility
in the lower parts of the leg as the section of the digital nerve
does, and that, on the contrary, it seems to preserve it in the
skin ; and also because for affections seated below the fetlock
there is but one operation to perform, and thus the horse
needs not to be turned over or thrown down again; and
again because defective cicatrices of the fetlock and phalanges
are avoided. All these reasons are evidently very correct; but,
as will be seen further on, they are insufficient to ignore or
leave aside plantar neurotomies.

Goldman has employed the section of the median to
relieve lameness, following the data of Peters; but he has
performed it only against navicular disease and ringbones.

Baldoni divides the indications as follows :—1st, ‘‘ In sec-
tioning a part of the nerve well above the humero-radial joint,
before it furnishes the branch of the flexors, we suppress the
sensibility, not only in the sphere of the flexors, but in all the
half of the leg below the antibrachial, and hence to the foot.”

He then indicates to perform the operation at that height
when there are lesions of the tendons and of the lower regions
of the fetlock.

The partial excision of the median above the point where
the branch of the flexors is given off is irrational, as the
insensibility of the tendons is sufficient with the section of the
nerve below said branch. I will bring to the support of this
affirmation most conclusive facts. Besides, the internal flexor
of the metacarpus and the flexors of the phalanxes are
unnecessarily deprived of important motor threads. Indeed,
though this operation does not give rise to immediate paralysis
of these muscles, as I convinced myself in performing it,
on the 27th of November, 1892, upon a horse for experiment,
and which presented, until the day after, when he was
destroyed, a normal flexion of the lower part of the leg, I fear

MEDIAN NEUROTOMY n'3

later on an atrophy of the muscles, they being unnerved by
the posterior branch of the median, and specially of the
internal flexor of the metacarpus, which receives no nervous
influence from any other source.

The author does not say in his notes if, clinically, he
performed the operation to the height given.

2d. “In sectioning,’ continues Baldoni, “a part of the
branch which connects with the flexors, sensibility is removed
from them.”

This author has never used this excision therapeutically,
as he never had opportunity to; but he claims that it would
give good results in cases of chronic tendinitis only. I am
satisfied, on the contrary, that the operation will produce but
little, if any, loss of sensibility of the tendons; this being
specially due to branches given off from a lower point (see
anatomy). Finally, as in the section of the median nerve
above the branch of the flexors, there would consecutively
appear possible muscular atrophies.

dd. In continuing, Baldoni says again: “In sectioning a
part of the median nerve below the humero radial articulation,
after it has furnished the branch of the flexors, the sensibility
is entirely cut off in the lower half of the leg below the anti-
brachial (the foot includea), and the sensibility of the flexor
muscles remains intact.”

This is the only practical median neurotomy; I never
used any other. It cuts off the sensibility of the extremity
of the leg in part only; but, far from leaving that of the
flexors, as the author says, it takes enough of it off to remove
the lameness due to chronic tendinitis.

Baldoni recommends it only to take the place of plantar
neurotomies—that is, against navicular diseases and ringbones.

Then, again, he recommends it against shoulder lameness.
He says that plantar neurotomy has given good results in
similar cases, and that if cubito plantar neurotomy has given

12 MEDIAN NEUROTOMY

better results, it is because of its being nearer to the seat of
the disease. These facts are peculiar to the clinics of the
Milan School; the author gives no explanation of them, but
promises an early discussion of the same.

IT shall not comment upon them, but will only say that
they cannot be explained except by an error of diagnosis.

Bossi has based the indications upon experiments made
with the object of finding out what parts would lose their
sensibility through the section of the cubito plantar at the
different heights meutioned by Baldoni.

Peters has also already experimented with the same
object, for he says in his paper that one may be convinced
by pricks that the section of the median cuts off the sensibility
of the flexors tendons, but that this feeling remains in the
skin.

In order to explore the sensibility of the tendons, Bossi
has exposed them; he has pricked them with heated cautery-
needles, and then has introduced at various depths a lanceo-
lated needle.

The sensibility of the fetlock and coronet was determined
simply by pricking these regions.

In making the section of the median above the branch of
the flexors, he has found a diminution and sometimes a com-
plete loss of the sensibility of the tendons and of the internal
side of the fetlock and coronet. The external side of these
regions had, on the contrary, preserved almost a normal
sensibility. |

In performing the neurotomy of the flexors branch, a dimi-
nution in the sensibility of the tendons has been observed.

And again, in performing the median neurotomy above
the flexors branch, in place of the plantar, Bossi has found
the internal side of the foot free from sensibility, while the
external side, as well as the anterior face, remained as sensitive
as in the normal condition.

MEDIAN NEUROTOMY 13

Unfortunately,—and what seems to me more interesting—
Bossi has not attempted to find out in this last neurotomy
what became of the sensibility of the tendons, probably
because he thought, as he writes in his pamphlet—and no
doubt from an incorrect translation—that I performed
mesoneurectomy above the branch of the flexors.

He concludes by saying that neurotomy above the branch
of the flexors is the only one to perform, and only in cases
of tendinitis which have remained rebel to all ordinary
treatments; that neurotomy of the branch of the flexors and
that above it would not be sufficient to cut off the sensibility
of the tendons; and that the last operation is in no way
superior to plantar neurotomy.

On this last point, I am entirely of his opinion.

And now that the general ideas of those authors are
known, I will expose mine, which are for the most part based
upon the observation of clinical facts, having only in view
neurotomy of the median below the branch of the flexors.

As far as using it against navicular disease, sidebones and
ringbones is concerned, I have some reservations to make.

Ist. Navicular Disease.—I have not used the section of the
cubito plantar against that disease alone, as I consider that
there is no advantage to put aside the lower and double
plantar neurotomy, which is efficacious and is so very seldom
followed by complications. Mesoneurectomy evidently gives
some results, as observed by several surgeons; anyhow,
reasoning indicates it; but, in my: opinion, these results must
be less perfect than those obtained with the lower and double
neurotomy, because the organs contained in the hoof are still
sensitive on the external side through the influence of the
cutano-cutaneous. For the same reasons, it would probably
be less dangerous for the foot, but, on the other hand, it
would partially and without advantage unnerve the regions
situated between the upper part of the fore-arm and the coronet.

14. MEDIAN NEUROTOMY

In pathology, perturbations must not be uselessly pro-
duced ; a good treatment, whatever it may be, and which has
shown its results, must not be thrown aside for another, until
this one has proved itself positively superior to the other.
Such is not the case to-day, and I shall continue to use low
and double neurotomy against navicular disease.

2d. Sidebones and ringbones. — When these blemishes
exist only on one side, it is better to have recourse to plantar
neurotomy, high and unilateral, which is very efficacious and
generally free from subsequent complications.

When one has to treat cartilaginous or phalangeal bony
deposits, existing on each side or all round the fetlock and
coronet, I thought in my former communications, as it has
been proved that median neurotomy is absolutely harmless,
that it could be employed with better advantage thaa high and
doable neurotomy, which is somewhat dangerous. In accord-
ance with these ideas, I performed it, on the 17th of July,
1894, upon a horse which was very lame in the near fore-leg
from a large periostosis of the coronet, resulting itself from
an incomplete fracture of the os coronoe. (Observation XIT.)
Immediately after the operation the animal was much
improved, and less lame, probably from the shock upon the
nerves, as the next day the lameness was greater, the following
day still more marked, and after a few days it had returned
to the same degree as previous to the operation. It lasted
after the cicatrization of the wound. ‘The result was conse-
quently negative, and three weeks after I had to perform the
high and double operation. I could have operated then only
on the outside, as the inside was already rendered insensitive
by the mesoneurectomy; but I was desirous of having the
opportunity to test the sensibility of the two plantar nerves.

Here is what I observed :

During the various manipulations performed on the
internal side: viz., incision of the skin and perinervous cellular

MEDIAN NEUROTOMY 15

tissue raising and section of the nerve, sutures of the skin, the
animal exhibited no reaction, the sensibility was entirely gone.
On the outside, on the contrary, the struggles were as violent
as they generally are in all neurotomy, varying as they do
according to the excitability of the subject.

Immediately after this second operation the animal was
free from lameness, even in trotting, and the clandication did
not return at least for a month, or about during which time I
was able to observe him. After complete cicatrization of the
last wounds he was sold.

This case, or rather experiment, for it was really one,
shows that median neurotomy is insufficient for exostosis
located around the coronet; that it can only give a moderate
relief; and that it can produce a radical cure only in a case
when there is no pain on the external side. It is therefore
useless against lesions existing only on thatside. This failure
of the operation against all affections having their seat below
the fetlock, is due to the fact that the sensibility is partly kept
up by the external plantar nerve.

At any rate, every time I have had recourse to mesoneu-
rectomy against chronic tendinitis complicated with periostosis
of the external side of the coronet or pain in the foot on the
same side, I have only obtained improvement. (Observations
Pi VAL, VILE, XV: and: XV.)

Therefore, for double ringbones and sidebones, I shall
continue to perform high and double neurotomy. Unfortun-
ately, it is somewhat dangerous and ought not to be performed
except with care. For instance, it is not rare, when a leg has
double sidebones, to see that the lameness is caused only by
one of the two; in this case it is prudent to unnerve only first
on the side which seems to produce the lameness (oftener it
is the most recent instead of the largest), and, if unsuccessful,
to operate then on the other side.

At times the periostosis is only on the anterior face of the

16 MEDIAN NEUROTOMY

coronet. In this peculiar case, Baldoni says he obtained good
results with the section of the median. This is possible; but
I will consider it later.

3d. Chronic Tendinitis—In general, anterior chronic ten-
dinitis, whether it involves the carpal reinforcing band, the
proforans, perforatus, the suspensor ligament or several of
these organs together, is the morbidness against which
mesoneurectomy is specially indicated, against which it
is always successfully employed. I can make this state-.
ment, having performed it myself a number of times and
oftener alone than any of the authors who have written on the
subject. (Observations IT, Il.; TY., and’ V. Vi, 1X} andi
XI, XIII, XIX. and XX.)

very practitioner knows how the sprains of the ligaments
and of the tendons that posteriorly support the fetlock are
frequent in horses used on the pavements of large cities, and
especially those of Paris. Every one also knows what serious
affections these tendinites constitute. Blisters, actual cau-
terizations applied several times, most ordinarily give only
temporary relief, or only allow a slight service afterwards, but
very seldom and almost never bring on complete recoveries.

Ordinarily the lameness continues, at times less severe, at
others more marked, no matter what mode of treatment is used.
To this affection is frequently added, after more or less time,
the no less serious complication of knuckling, against which we
are powerless, as tenotomy only gives temporary relief. And
then the animal affected with tendinitis becomes, in the
majority of cases, unable to perform remunerative work.
After a long time, sometimes after years of treatment, during
which he has done but little work, he has to be killed.

In these conditions one is in presence of a serious accident,
against which there was so far no good mode of treatment.
One presents itself, “median newrotomy,” which is bound to be
accepted by veterinarians without fear of throwing useless

MEDIAN NEUROTOMY U7

perturbations in pathology, as itis, bevond any doubt, superior
to all treatments precedently tested.

Mesoneurectomy is to be used with judgment against
chronic tendinitis. Thus it would certainly be dang2rous
to employ it at the beginning of the affection when
softening and a complete giving way of the tendons might
take place. And again, as the known treatments might in
some cases prove sufficiently successful to allow the animal to
be used at slow work, it is prudent not to be hasty. I estimate
that about four weeks after the beginning of the lameness one
may operate without fear of the rapid accidents on the
tendons, as after that time one may be certain as to the
efficacy of the means previously employed. One must, how-
ever, be careful not to put off too long, as knuckling sometimes
appears rapidly, and if median neurotomy does not remove
this difficulty Iam certain that its manifestation can be pre-
vented, the operation having for result to produce the free
resting of the extremity on the ground.

The excision of the median has given me immediate and
better results when the tendinitis existed in the upper part of
the tendons.

Mesoneurectomy will also give gocd results in cases of
tendinitis existing in concordance with a ringbone situated on
the inside of the coronet.

4th. Periostosis of the Fetlock.—Upon a horse for experiment
suffering with periostosis of the fetlock (probably after a
sprain of that joint), against which cauterization in lines had
been applied, and which periostosis had given rise to severe
lameness, median neurotomy, performed December 4th, 1892,
failed to give immediate results. Itis true, however, that the
lameness might have disappeared later on.

Of course the experiment was not encouraging, but not-
withstanding, on the 9th August, 1894, with Congis, veterinarian,
at Crépy-en-Valois, I performed in this locality the section

18 MEDIAN NEUROTOMY

of the median nerve against an enormous periostosis of the
fetlock, due to an arthritis following a prick of a pitchfork
received in 1891 (Observ. XVI). The lameness remained after
the operation as it was before, viz., very severe.

At the beginning of November, 1894, Congis informed me
that the lameness had diminished very much and that the
animal had resumed the work which he was obliged to quit
before my intervention. In the meantime, the same veterin-
arian informed me that on the 9th of September, 1894 (Observ.
XVII), he had operated with complete success on a mare
belonging to him, against a periostosis of the fetlock of several
years’ standing, overcoming severe lameness.

And again, the 3d of November, 1894 (Observation X VIID),
I myself operated with advantage against a similar case.

These facts prove that the section of the median can give
good results against the periostosis of the fetlock, and suggest
the use of it in cases of lameness resulting from it when all
other means of treatment have failed.

The wonderful effects of mesoneurectomy against chronic
tendinitis of the fetlock may surprise, as anatomical knowledge
(see anatomy below) teaches us that the cubito-cutaneous
co-operates for a small part in the innervation of the tendons
and of the fetlock.

Clinical facts, however, must be respected.

They can nevertheless be explained by the admission that
with the section of the median nerve a sufficient diminution of
the sensibility is obtained to remove the lameness due to the
tendinitis and to the periostosis of the fetlock, but that the
innervation of the tendons and of the metacarpo-phalangeal
joint has not been completely destroyed. This is fortunate,
and explanatory of the rarity of accidents following median
neurotomy.

5th. Periostosis of the Knee.—Mesoneurectomy, it seems to
me, ought to act advantageously against periostosis of the

MEDIAN NEUROTOMY 19

carpal joint. Wpon a horse for experiment, one of whose
knees was surrounded with exostosis, producing much lame-
ness, this was as marked after as before the operation, which
was performed the 4th of December, 1892; of course the lame-
ness might have subsided later on, Perhaps, as said Moussu,
this failure was due to the fact that the majority of the
pericarpal nervous threads (divisions connecting with the
synovial, the ligaments and all the subcutaneous tissues) are
furnished specially by the radial and musculo-cutaneous nerves.

Nevertheless, as soon as I have the opportunity I will

renew clinically this experiment.

Surgical Anatomy of the Region.— Before describing
the operation let us glance at the anatomy of the region.

Peters and Goldmann have failed to give us any. In my
first communication, I have, from many dissections, described
surgically the region where the section of the median is made.
Baldoni and Bossi have given the descriptive anatomy of the
two principal nerves (median or cubito-plantar and cubital or
cubito-cutaneous) of the fore-leg.

Surgical anatomy being the only one realty useful, I repro-
duce it as I formerly gave it, insisting, however, somewhat more
minutely on that of the nerves.

The region upon which median neurotomy is performed,
situated at the internal and upper part of the fore-arm, may be
limited; above by the axilla, below by the union of the upper
with the middle third of the fore-arm, in front, by the skin
which covers the internal border of the radius; behind by that
which lies on the internal border of the internal flexor of the
metacarpus.

It can be divided into three superposed layers: Ist, th
outer; 2d, the middle ; 3d, the inner.

I. Outer Layer (Figs. 6 and 1).—It includes, Ist, the skin

20) MEDIAN NEUROTOMY

(P); 2d, the inferior and posterior part of the sterno-apon-
euroticus (S. A.) and its aponeurosis (A. s. a.)

1st. Skin.—It is thin and mobile, becomes thicker down-
wards and forwards; up, it forms wrinkles or folds more or
less numerous according to the subjects; the hair is generally
not abundant, but long and fine.

2d. Inferior and Posterior part of the Sterno-Aponeuroticus.—
Under the skin, to which it is united by dense and close cellular
tissue, is the lower part of that muscle which shows itself
under the aspect of light red fibres, parallel to each other and
running in the direction of the leg. This muscle, thick above,
becomes thin downwards, to end 6 or 10 centimeters below the
upper extremity of the radius in a very thin aponeurosis which
continues its lower part. Hence, the immediate indication not
to operate too high, so as to have only a thin part of the
muscle to divide.

II. Middle Layer (Fig. 1).—Is formed by the antibrachial
aponeurosis (Ab).

Antibrachial Aponeurosis.—Very strong and resisting, and
of a nacreous, white color, it surrounds the fore-arm in form-
ing a sheath to the muscle. It is attached on the internal
border of the radius. Its external face is united to the inter-
nal face of the sterno-aponeuroticus by conjunctive tissue very
dense and divided into several layers. As soon as the fleshy
portion of the sterno-aponeuroticus is continued in its lower
part by its fascia, the connective tissue disappears almost
entirely, becomes very rare, and the two aponeuroses are then
intimately united together.

III. Inner Layer (Fig. 2, 3, 4 and 5).—It is made up of
Ist, (in front) the upper portion of the internal border of the
radius (R) with the internal lateral ligament of the humero-
radial joint; 2d, (behind) the superior part of the internal

PLATE J.

Fig. 1.—Superficial and Middle Layers.—Ab, antibrachial aponeurosis ;
Asa, terminal aponeurosis of the sterno-aponeuroticus ; FI, internal
flexor of the metacarpus ; N, median nerve; P, skin; 5 A, sterno-
aponeuroticus muscle ; V, posterior radial vein.

Fig. 2,—Deep Layer.—A, posterior radial artery ; FI, internal flexor of
the metacarpus; N, median nerve: N’N’’ posterior nervous
branches ; P, skin ; R, radius ; V, V’’, posterior radial veins.

ae

ee et ay yl me

‘

ri

¢

MEDIaN NEUROTOMY BAL

border of the internal flexor of the metacarpus (Fi.); in the
middle, 3d, the median nerve (N.); 4th, the posterior radial
artery (A.); 5th, the posterior radial veins (V. V.’ V”).

Ist. Radius and Internal Lateral Ingaments of the Humero-
Radio-Cubital Joint—To the internal part of the superior
extremity of the radius is found, in front, the bicipital tuber-
osity to which the biceps (coraco-radialis) is inserted; behind
this tuberosity and at the same height, there are rough
impressions for the attachment of the internal lateral
ligament of the joint. These impressions are very import-
ant, as they serve to determinate the selective spot for the
operation.

Lower down the internal border of the bone, thick and
rounded, is in immediate contact with the skin.

The internal lateral ligament of the elbow articulation,
which extends from the humerus to the radius, is interesting,
because it is covered by the median nerve, the posterior radial
artery and veins.

2d. Internal Fiexor of the Metacarpus.—This muscle, situa-
ted against the posterior face of the radius, is elongated from
above below and wider in its middle. It flexes the cannon.
When exposed, it appears of a dark, red color, its fibres run-
ning vertically.

3d. Median or Cubito-Plantar Nerve.—Leaving the poste-
rior part of the mass of the brachial plexus, it is the satellite
nerve of the humeral artery and one of its terminal divisions,
the posterior radial.

In company with this artery, the nerve passes on the
internal face of the articulation of the elbow, then of the upper
and internal tuberosities of the radius. When it reaches 5 or
6 centimeters below the articular edge of this bone, it pene-
trates between the posterior face and anterior border of the
internal flexor of the metacarpus, to which it closely adheres.
Therefore, it becomes necessary to perform the operation

22 MEDIAN NEUROTOMY

sufficiently high to reach the nerve before it penetrates
between the bone and the muscle. :

A little above the carpus, the median bifurcates to form
the metacarpal nerves, viz., the whole internal one, while the
external is constituted by the union of one of those bifurcations
with the end of the cubito-cutaneous.

Below the articulation of the elbow, one and rarely two
branches of the cubito-plantar (two in fig. 2, N.’ N.”) are given
off and run outwards and backwards into the internal flexor of
the metacarpus and in the flexors of the phalanges. This
branch (the highest when there are two) must, as we have
shown in the indications, be respected by making the sections
sufficiently low.

Further down, several nervous divisions rise from the
median to ramify in the muscles of the posterior antibrachial
region, and the metacarpal nerves also stretch out their
branches as far as the knee, the temdons of the flexors of the
phalanges and the fetlock. The internal, towards the middle
of the cannon, sends to the external a sub-cuvtaneous
anastomosis.

On the level with the fetlock the metacarpal nerves
become plantar and give several anterior and posterior
branches which ramify in the various parts of the phalangeal
region.

Ath. Posterior Radial Artery -- One of the terminal branches
of the humeral artery whose direction continues, it is
always situated a little deeper than the nerve which accom-
panies it.

5th. Posterior Radial Veins.—They are the continuation of
the metacarpal veins. Three or four in number, often anas-
tomosed together, they run upwards on the posterior face of
the radius, accompanying the posterior radial artery, and
sometimes the median nerve, and surrounding it with a
veinous fasciculus.

PLATE II,

Figs. 3, 4 and 5.—Deep Layer (abnomalies).—(The veins are not represen-
ted in fig. 5.) A, posterior radial artery ; FI, internal flexor of the
metacarpus ; N, median nerve; N’’, posterior nervous branch ; R,
radius; V, V’, V’’, posterior radial veins.

Fig. 6.—Third Step of the Operatio:.—T, preéminence formed by the
internal and superior tuberosity of the radius.

—

5

er oe :
fa,

=i

MEDIAN NEUROTOMY 25

Relations between the Nerve, Artery and Veins.—On a
level with the internal lateral ligament of the elbow joint, one
finds, going from forward backwards, a posterior radial vein, the
posterior radial artery, the mediam nerve and a second poste-
rior radial vein (fig. 2). Going downwards, a few centimeters
below this point, all these organs disappear between the radius
and the internal flexor of the metacarpus. It is first the vein
behind the nerve which penetrates under the muscle, then the
artery which, in order to do this, passes under the nerve. The
vein in front of the nerve, and which has also to pass under it,
comes afterwards. Last comes the cubito-plantar itself, which,
lower down generally, remains superficial in a greater length,
a most favorable condition, as there is less risk to injure the
blood-vessels.

At the point where the neurotomy is to be performed—that
is, where the nerve disappears—it is first intimately related to
the posterior and then to the superior or face of the vein situa-
ted in front of it; the artery is covered by both.

Further down, between the bone and the muscle, from the
outer to the inner parts, the nerves, vein and artery are found;
(this is not illustrated in our plates).

These dispositions are not always constant: for instance,
in fig. 2, the vein situated in front, runs down as low as the
nerve ; in figs. 3 and 4, there are three veins; one in front of
the artery, one between it and the nerve, and one between the
nerve and the internal flexor of the metacarpus ; besides, in fig.
4, the front vein disappears the last under the muscle. In
passing downwards, it had remained superficial to the nerve,
which would have rendered the operation difficult. In fig. 5,
the relations are still more abnormal, as the artery is entirely
back of the nerve.

The operator must not be deterred by these abnormal
conditions ; a little skill and attention will isolate the median
without injury to the vessels accompanying it.

24 MEDIAN NEUROTOMY

OPERATION.:

I have already performed this operation a great many
times, either for experiment or with a therapeutic object. I
will therefore describe it, the modus operandi that I have
followed, mentioning the modes used and employed by others
when they present special peculiarities.

To begin with, a first question presents itself: When a
horse is affected on both anterior extremities, with diseases
which necessitate the use of mesoneurectomy, can he be oper-
ated on both the same day? I can, without hesitation, answer
in the affirmative, as in three occasions (Observ. IX and X,
XIV and XV, XIX and XX) I have, without any trouble, ~
made the section of the two medians at one sitting.

Instruments and Dressing.—The instruments that are

necessary are: curved scissors, two bistouries, one convex and
one straight, a grooved probe, bull-dog forceps, artery forceps,
a blunt tenaculum, a blunt curved tenotome, two-pointed
tenacula, all very clean and kept on a tray. To apply the
dressing, if one is judged necessary, use suture needle, strong
thread, or better, carbolized or sublimated silk and iodoformed
gauze. As a dressing proper, carbolized cotton, solution of
van Swieten, or any other antiseptic liquid ought to be ready

in sufficient quantity.

Preparation and Securing of the Animal.—The day
before the operation, the foot of the lame leg is carefully
examined, and if an acute disease is found, neurotomy is post-
poned until complete recovery.

Baldoni, before throwing the horse down, produces artifi-
cial ischemia. The leg is enveloped from the coronet to the
elbow with an elastic band, and at that point an India rubber

MEDIAN NEUROTOMY 25

tube is tightly applied when the band is removed, the tube
being kept in position by being secured to the withers with a
string. This, however, Baldoni does not consider as indispen-
sable. I am not only of his opinion, but consider it useless.

The subject, without having been previously fed, is thrown
on the side of the leg to be operated on.

Goldmann recommends chloroformization. I have never
used it; it is not indispensable, and therefore should be
discarded. 3

To expose the internal and superior face of the fore-arm,
all that there is to do is to remove the outer fore-leg from its
hobble and secure it on the corresponding hind ones above
the hock. This mode is used by Goldmann. I have used it
also, but have discarded it, as it does not permit sufficient
access to the region, and then one is exposed to operate too
low down. Peters, besides, carries the leg to operate forward
with a flat leather strap and prevents its free motion forwards
by tying it with a rope to the corresponding hind leg. In
some cases this process must hardly be sufficient.

I prefer to carry the leg to be operated forward with the
bar-hobbles; one of the hobbles is fixed on the fetlock of the
fore leg and the other on the cannon of the hind leg on the
same side. At the same time, while the outer leg is secured
as above stated, the lower one is kept extended by pulling on
a rope attached on its fetlock.

Some German operators, to obtain the same result, use
a pole which passes under the neck at its base, and is
fixed on the cannon or fetlock, and held forward by assist-
ants. I have obtained good results by this process, though
with powerful animals the restraint would certainly be in-
adequate.

Preparation of Region.—The hair must be clipped upon
the supero-internal part of the fore arm. The parts must be

26 MEDIAN NEUROTOMY

soaped, washed, cleaned with the solution of van Swieten, and
thoroughly dried with a clean cloth.

Bossi recommends local anestheria with cocaine injections
in the part to be operated, of 8 cubic centimeters of 4 per 100
solution. This injection is followed by a little massage to
facilitate its introduction deeper, and its effects upon a broader
surface. Before beginning the dissection of the nerve, he also
recommends to drop a little of the solution in the wound.
These, he says, render great assistance in relieving the sensi-
bility of the median.

I am of his opinion, though it appears that cocaine inter-
feres with the healing of the wound. This anesthesia had
already been recommended in plantar neurotomy (De Jouy,

1889).

Elective Place.—I will not mention those named by
Baldoni, they are useless; I will simply say that outside of
the three places that he speaks of, to divide the cubito-plantar,
he recommends a fourth one lower, a little above the middle
of the internal face of the fore-arm. It is there, he says, that
the greatest difficulty exists, because the nerve is situated so
deeply.

I agree with him, this place must be discarded.

The place of election must be measured in height and from
forward backward.

Ist. In Height.—As I have shown in the anatomy of the
region, the operation must be done, in my opinion, sufficiently
low to avoid a greater thickness of the sterno-aponeuroticus
as well as the incision of the nervous branch of the flexors, and
sufficiently high, however, to reach the median, previous to its
entrance between the bone and the muscle. Consequently the
nerve must be excised at the point where it is about to
disappear.

This point is immediately under the round eminence

MEDIAN NEUROTOMY 27

formed superiorly by the articulation of the elbow and in-
feriorly by the bicipital tuberosity and the rough impressions
which prolong it backward (fig. 6). The incision shall then
begin immediately below the termination of this eminence and
extend downward. In large horses, it shall be about the width
of a finger higher up.

9d. From Forward Backward.—This is easier to indicate;
when the first point is found, all that is required is to feel for
the posterior border of the radius; the incision is made imme-
diately behind and in the direction of this border. I recom-
mend to make the incision a little back of the bone, so as to
avoid the cutting of the vein, which is always in front of the
nerve there.

The pulsations of the posterior radial artery in fine horses
will also facilitate the research of this place of election. Then
the incision will be made en the point, where the artery is felt
the lowest down.

Peters and Goldmann give as datum the place where the
radial pulse is felt. This is not sufficiently precise, as, among
most horses, the pulse can be felt upon a length measuring
from 8 to 10 centimeters. It is where the pulse is felt the
lowest down that the true place of selection is situated.

Modus Operandi.—To facilitate the description, I shall
divide in three parts:

1st. Incision of the skin and of the sterno-aponeuroticus.

2d. Incision of the antibrachial aponeurosis.

3d. Dissection and excision of the nerve.

1st. Incision of the Skin and Sterno-aponeuroticus.—The sur-
geon places himself in front of the leg to operate on. The
skin being stretched at the point of selection, an incision is
made with the convex bistouri, beginning at the point above-
named and extending downwards from three to four centime-
ters in the direction of the leg.

28 MEDIAN NEUROTOMY

The sterno-aponeuroticus is then well exposed and is
divided in a similar way. This muscle differs in thickness, as
it extends downward more or less in the various animals.
Ordinarily it is quite thin, and the incision, beginning upon the
muscular part itself, ends at the point where it is continued
by the aponeurosis. In other cases the incision does not
reach downwards to the extremity of the muscular fibres; and
again at others, it goes beyond them.

While this is being done, there is a small hemorrhage,
which soon stops of itself.

When the incision is made, the edges of the wound are
spread open with the tenacula held by assistants.

Peters, instead of these, keeps the wound open by passing
a piece of cotton tape through the edges thus kept apart by
opposite traction on them, one forward, one backward and a
little dewnward, to stop the hemorrhage.

Baldoni uses special forceps or tenacula whose jaws,
divided in several teeth, are curved and pointed.

I think these are practical and might be used.

The connective tissue covering the antibrachial aponeu-
rosis is carefully dissected and divided so as to expose it, when
it will appear with its handsome, white nacreous color.

2d. mcision of the Antibrachial Aponeurosis.—An incision,
similar to the preceding, is made in that aponeurosis when
the hemorrhage has stopped.

This part of the operation is quite difficult, as in doing it
one must be careful to avoid injuring the posterior radial veins,
which would render the balance of the operation very difficult.
To this effect the incision is carried a little backwards, and by
raising the aponeurosis with bull-dog forceps, it can be safely
divided with a bistouri, or, as Peters indicates, with scissors.

Here Goldmann operates in the following manner: At
the lower end of the first incision, he makes into the antibra-
chial aponeurosis a puncture large enough to introduce a

MEDIAN NEUROTOMY 29

curved, blunt tenotome, with which, the sharp edge turned
upwards, he divides the aponeurosis, in length equal to that of
the cutaneous incision.

Though not indispensable, I have found this measure
advantageous in the cases in which I have employed it.

When this is done the dark coloration of the internal
flexor of the metacarvus is seen, indicating that the nerve may
be looked for. Until this musele is in full sight, it is useless
to attempt searching for the nerve.

3d. Dissection and Excision of the Nerve.—At the same
moment that the muscle is discovered, often in front, the nerve
is often seen in front. It is recognized by its whitish color, its
flattened form, filamentous structure and its sensibility.
Ordinarily, one also observes a large, dark vein in front of the
median, which rests on its posterior face and lower down over
it, on the superior one.

The artery remains most always concealed by the nerve
and the vein; however, in some instances, it is readily discoy-
cred. The connective tissue which covers the cubito-plantar
is carefully divided with a straight bistoury, the veins being
carefully avoided. The grooved tenaculum may be used to
isolate the nerve.

When the dissection of the nerve is sufficient, it is raised
gently, and the curved scissors introduced under it from forward
backwards (fig. 6). Instead of the scissors, a blunt, curved,
erooved tenaculum can be used to raise and hold the nerve.
In fact this instrument is preferable, and of late I have used it
entirely, as with it the nerve can be secured easily, more
readily, and without danger for the surrounding blood vessels.

When the scissors are used, holding them flatwise, they
are turned half way so as to allow the introduction, under the
isolated part of the nerve, of the straight bistoury, or better,
the curved, blunt tenotome with the sharp edge turned towards
the sternum, when the nerve is divided by one stroke of the

30 MEDIAN NEUROTOMY

instrument. If the nerve has been raised in using the blunt
curved tenaculum, the introduction and division of the nerve
is made with the sharp instrument introduced also under the
nerve, elevated by the tenaculum.

The lower stump of the nerve, which has retreated into
the wound, is taken hold of with the forceps, and excised in a
length of about two centimeters.

German and Italian operators secure and raise the nerve
with a silk thread passed underneath it; the section of the
nerve being made above and below the ligature.

On account of the violent struggles of the animal it is
difficult to take hold and divide the nerve with forceps only,
as is sometimes done in plantar neurotomy.

In some instances the incision is a little too low down,
and only the internal flexor is seen; in such cases remember
that the cubito-plantar is then intimately related to the
anterior border of the muscle, and that in the dissection one
must not mistake the vein for the muscle, as the section of the
first would be most serious.

At any rate, in following these rules, it is impossible to
mistake the vein for the nerve.

The difference between the artery and the nerve is seen in
the round shape and the light, rosy color of the first. These
peculiarities will be readily observed when the vessel looked
at is at the bottom of the wound; when it is pulled out of it
with the scissors, these peculiarities will disappear and a mis-
take might be made. Moreover, the want of sensibility of the
artery and the presence of the pulse will suffice to distinguish
between the two. The diagnosis between the nerve and the
artery ought to be made with the blood vessel at the bottom
of the wound.

Dressing.—The wound is carefully washed with liquor of
van Swieten. In the beginning J used to dress the wound
somewhat. I introduced a little iodoformed gauze in the

MEDIAN NEUROTOMY Bill

wound, and held it in place with two or three stitches of the
skin. It certainly would be possible to apply sutures on the
skin only, covering the parts with iodoform collodion and thus
have all the requirements of a severe antisepsis sufficient to
obtain a cicatrization by first intention. This is often obtained
in plantar-neurotomies and specially in the external high and
low operations. For the internal, the manipulations of
restraint, the hobbles, &c., are more than suflicient to prevent
immediate reunion, specially in cases of the low operation.
Goldmann has obtained two cicatrizations per primam in hav-
ing a continual disinfection of the parts before and during the
operation, and in closing the wound with a pin suture and
elueing it with collodion. Now I use no longer dressing or
suture; after the washing of the wound, I cover it with iodo-
form, and the cicatrization is more rapid. Goldmann had
already done the same—it is simpler and better.

Peters apples a little sub-cutaneous wadding dressing.

Baldoni, after washing the wound, puts a drain tube in it,
holding it in place with stitches. This drain tube is useless
and disturbs the cicatrization.

Bossi makes a cat-eut continued suture of the sterno-
aponeuroticus, and one interrupted or twisted on the skin. He
uses no drain tube dressing, but now applies a flat dressing
held into place by several turns of dextrined gauze, which is
changed every three or four days. This last measure is cer-
tainly useless.

Immediate Ejfects.—1st. In action.—Almost always, even in
trotting, immediately after the operation, a great diminution
and often a complete removal of the lameness is observed. In
all the horses that I have operated for chronic tendinitis, this
immediate result proved absent but once (Obs. XIIT), and
notwithstanding, the lameness disappeared later on. This
fact is not uncommon in other neurotomies and therefore is
not surprising.

Se)
bo

MEDIAN NEUROTOMY

In periostosis of the fetlock, in three operations made
for therapeutics, there was complete disappearance of the
lameness in two; in the third it became less severe, but only a
few days later disappeared entirely.

2d. At Rest.—Returned to his stall, the animal stands
almost constantly on the operated leg, which is no longer
carried forward, and often resting and relieved from support-
ing its share of the body. I have never seen this condition
missing. When the subject has chronic tendinitis of both fore
legs, and that the most diseased one is operated first the
effects are still more striking. Before the operation, it was
naturally the less affected leg that would carry the most weight
of the body, but as soon as the median nerve is cut, the con-
trary is observed; the operated leg is almost always carrying
weight while the other is at rest and carried forward.

This phenomenon proved most remarkable after the
second, fourth and fifth neurotomies. It even showed itself
later on after the operation, when the inflammation of the
repairing process was present.

After Cares.—Tf, as lrecommended at first a small dressing,
of idoformed gauze has been made, the next day it is removed
after cutting the stitches and the wound is exposed. Evcry
day this is wel! washed with Van Swieten solution or any other
antiseptic solution, then covered with iodoform and carbolized
vaseline until completely healed. Weather permitting, douches
can be made on the forearm, specially if there is swelling.

If no dressing is used, the same cares of the wound are
indicated. |

Goldmann, in the cases when, to obtain immediate cicat-
rization, he had applied a pin suture, has sometimes seen
after three days a raising of the stitches caused by the forma-
tion of pus, and on that account has modified the treatment
and adopted that of the wounds uncovered. If, with the same
object, a simple cutaneous suture was used, one would have to

MEDIAN NEUROTOMY ae

watch for the possibility of this suppuration and then remove
the threads, as soon as it would show itself.

Except Goldmann, who recommends to exercise the horses
after fourteen days, foreign authors say nothing as to the
considerations to be taken to return the operated to their
work. After several hesitations, I have accepted the following
indications: fifteen davs of complete rest, eight days of slow
walking, during which walking the horse should always be
led, eight days of light work, eight days of moderate work,
then return to the steady ordinary service.

Only about four weeks of rest are necessary, and this
cannot be termed too long an illness.

During the three months following the operation, the foot
is shod with care and in such a manner as to stop from the
start the morbid manifestations which might occur.

After Ejjects—The day following the operation, there is a
small swelling round the incised structure; the following days
it subsides, running down to the knee, and after a short time it
disappears. The wound cicatrizes rapidly; in a fortnight it is
all closed.

In some animals, there is the next day some difficulty in
moving the operated leg, which is carried slowly and a little
forward, while yet the toe drags on the ground. Still the rest
in the stable is freeand plumb. This stiffness disappears after
a few days; it is due to the inflammation following the neuro-
tomy and also principally to the incision of the sterno-aponeu-
roticus. I have observed that the higher the muscle is divided
the greater the stiffness.

After the time required, the animals when returned to
their work do not go lame, even in trotting.

The after effects are complete only after about two months.

Tt means that until that time, the operated animals, while
able to work without lameness, become more and more free in
thoir movements.

84 MEDIAN NEUROTOMY

Goldmann says he has observed in all the sections of the
median that there is a great increase in the growth of the
hoof.

Ts it not a preconceived idea, as if, on one side Brauell
(1857) claims that ‘‘ the hoof grows so much more rapidly as the
foot is more neurotomized;” on the other, Chauveau (1853), after a
section in the upper part of the forearm of all the nerves,
ramifying in the lowest part of the leg, only remarks that
“such neurotomy, as complete as possible, has not interfered at all
with the nutritive and secretory actions of the dermis.” Comeny
(in 1887), after a series of experiments with high neurotomy,
comes to the same conclusion; and we may add that French
practitioners have never spoken of this increase in the growth
of the hoof after the same operation.

And again, after mesoneurectomy, I have never seen any
change in the growth of the hoof,and I have had several
animals under observation for more than two years.

This peculiarity, however, has no importance and deserves

no longer discussion.

Accidents.—Ries and Hendrickx have observed, after the
neurotomy of the median made at Cureghem, an accident, that,
according to the former, assumed the form of chronic laminitis,
but which, according to the latter involved the foot and its
tendons. Whatever they may have been, these accidents were
very serious, as the animal had to be destroyed.

Was not there perhaps another startling cause ? Notwith-
standing, it can be said that the Belgian operator was
unfortunate, as in sixty-one cases of neurotomy on the median
that I know, this is the only one I find on record. The two
accidents mentioned in my original communication were made
through mistake.

At the beginning, I was afraid of the softening of the
tendons and of the ligaments, sloughing of the hoof, rebel
cicatrization of the wounds, but at present I am entirely reas-

MEDIAN NFUROTOMY 35

sured as, with the exception of the above mentioned case,
none of these accidents have been seen.

And again, in supposing that some lacerations of tendons
should have occured, it would not be an evidence that meso-
neurectomy had been the cause; as it is 2 known fact that if a
horse suffering with chronic tendinitis is kept for a long time,
an elongation of the tendons may take place. Delperier told
me of a remarkable case; a horse which its owner cared very
much for, was affected with tendinitis of both fore legs and
was entirely disabled; for years he had not worked; one day,
to have a consultation of the great master, Henry Bouley,
then Professor at Alfort, the horse was started to go to the
school, but at a short distance from it he stopped and fell; the
tendons of both fore legs were ruptured.

In fact, tendinous zuptures have been known without
previous chronic tendinitis.

In my first communication I had assimilated median
neurotomy to that of the sciatic nerve, performed by Rousseau
and reported by Benjamin, who spoke of a softening of the
tendons after the operation of Rousseau and expressed the
fear that it might also occur after mesoneurectomy. I wish
to insist in remarking that accidents must be less common
after sciatic than after median neurotomy, as with the first
the actions of both metatarsal nerves and therefore the two
plantar (digital) which continue them, is entirely destroyed,
while in the second the external metacarpal nerve is left
with a certain action, formed, as it is, partly by the cubito-
cutaneous.

Out of 17 cases of median neurotomy, Goldmann has seen
once, in an animal with weak feet, a well-marked dropping of
the sole. Was it due to the operation?

Weber has told of a horse, which, neurotomized for
chronic tendinitis, had later on generalized periostosis of the
cannon and of the coronet.

36. MEDIAN NEUhOTOMY

Congis (Observation XIII.) observed, four months after
the operation, some induration in the fold of the coronet.

It is not proved that these two morbid manifestations,
somewhat similar to each other, were due to median neuro-
tomy, as I am informed that it could not be said whether they
had not started previous to the operation. And even if they
had started after, it would not be evidence that the operation
was the cause of them; examples are very numerous of their
appearance without section of the median; the horse of the
eighth observation proves it.

It will be only later, if it is found that these indurations
occur frequently after the operation, that median neurotomy
can be accused of being the cause.

At any rate, these hypertrophies are not serious; in the
ease recorded by Weber, the animal that had been mesoneurot-
omized on both legs, was able to work for two years after with
those pericstoses, and was killed afterwards, not on account of
them, but because he was completely worn out. As to the
ease of Congi, he was not either disturbed by the induration
of the fold of the coronet, the author himself reporting him as
perfectly cured.

Until the present time, no painful neuromas has been
mentioned as following mesoneurectomy, a complication which
is so common in plantar-neurotomy, even after cicatrization of
the skin. I must remark that as far as the coming on of neuromas
goes, there is certainly a predisposition to them, as I have seen
a horse who had four neuromas after four high neurotomies.

Accidents due to the section of the median are therefore
generally very rare and not serious, which is explained by the
fact, as already stated, that the innervation is yet partially
preserved in the lower parts of the leg through the eubito-
cutaneous.

Results.—In the following table are given all the opera-
tions published to this date with the results obtained :

eet tan

Table of Results of Median Neurotomy.

|
Z, |
Z |
- ey i) ae
z 8 = g
= 3 ch el eee)
DISEASES 5 8 Spay eaots
Ay ea oe | oe
|
Chronic Tendinitis. 1 Recovery = | _—
|
Chronie tendinitis
and lesions of the
tendons........ it Recovery _ —
|
Periostosis of the |
POLLOCK ieacr ee ee _— — _ oa
Side Bones....... = = ail | Recovery
(internal |
side)
|
Ring Bones....... 1 Recovery 1 | Recovery |
(kind un-
mention‘d)
{| Recovery |
| jin 13. In 1
: : a jreturn of
Navicular disease. . 2 Recoveries 14 4 | Teeeneds
| after four
Chronic lameness (| months
after a punctured
wound of the foot a — Recovery —
Shoulder lameness —_ — — —

g
iS} a *
5 = A : SI Z
) 35} it Se} S £ S
3 Z 4 5 a = 5)
jan) [eu A oa a e a
ae zs 11 Recoveries = es =
(6 on 3
horses)
1 recovery
= — (2 dint the PEN A i 1 failure =
= same (probably
horse) above the
branch of
the flexors)
= _ 3 ; 2 recover’s ai: Se =
1 improv’d
(1_ opera-
tion by
Congis)
§ 3 recover’s
= a = = 6 2imp’m’t =
(|i failure
= om 1 Failure 4 § |3 recover’s 7
(/1 failure Gvithe din:
ease of the
foot not
(|, a No named)
cident. No
2 report on = = = = za
the other
case
= — = = 3 §./2 recover’s =
? 1 failure

8
r=) ZL f=
n Dn mn
ov =) o
oe pO em
— Ay Recovery
(above the
branches
of the
flexors)
Recovery — =

3 MEDIAN NEUROTOMY

By this table it is shown that the operations performed in
61 cases by different surgeons, have given 13 recoveries in 13
cases of chronic tendinitis; 2 recoveries, 5 improvements and
i failure in 8 cases of chronic tendinitis with lesions at the
coronet; 2 recoveries and 1 improvement in 3 cases of perios-
tosis of the fetlock ; 4 recoveries, 2 improvements, 1 failure in
7 cases of cartilaginous calcification (side bones); 6 discov-
eries, 2 failures in 8 cases of phalangeal exostosis (ringbones);
(it is to be regretted that in this last disease, the authors, and
Baldoni specially, have not mentioned whether the lesion
existed on the outer or the inner side, as, unless one is satisfied
with improvement only, recovery is possible only when it is
on the external side); 15 recoveries, 1 return of the Jameness
after 4 months, one failure followed by accident, 1 case with-
out after information out of 18 cases of navicular disease; 1
recovery in 1 case of old lameness after an operation for deep
punctured wound of the foot; and to finish, 2 recoveries (?)
and one failure in 3 cases of shoulder lameness.

Median neurotomy is then really efficacious against
chronic tendinitis and can render good services in periostosis
of the fetlock; for the other affections I have not experimen-
ted sufficiently to present conclusions, and my opinion on this
subject I have already given.

I wish, however, to remark that the section of the median
is compatible with a severe service. Observ. IV and V speak
of a horse from which I removed part of both cubito-plantar,
and which, notwithstanding, performed an exceptional service
for eighteen months afterwards.

Conclusions.—From the preceding facts and arguments, I
believe I have the right to place median neurotomy among
the practical operations and to advise its use without hesita-
tion in decided cases of chronic tendinitis or of periostosis of
the fetlock, when the ordinary forms of treatment have failed.

In such instances the veterinarian will have the satisfac-
tion of making an animal, then only fit to be destroyed, able to
perform good and long services.

a

PART SECOND.

OBSERVATIONS UPON MEDIAN NEUROTOMY
OBTAINED BY THE AUTHOR.

OpsERVATION L—On the 25th of June, 1892, was brought to
the clinic of Alfort a small mare, used for light draught, sherry
bay color, seven years old, measuring 1 meter 55 in height, the
property of Mr. G.

She had been bought of the Compagnie Générale des
Petites Voitures, for one hundred and some frances.

In trotting and even walking, she was very lame on the
off fore leg, which was the seat of a severe chronic tendinitis
with knuckling of the fetlock to the second degree. The swol-
len tendons showed evidences of a cauterization in points.

The owner states that in those conditions the mare is
useless and wishes that anything be done, dangerous or not, to
relieve her of her lameness.

I knew that in Germany neurotomy of the median had
been performed at the upper part of the radius; thinking this
was a case in which to try it, it was proposed and accepted.

Immediately the animal was thrown down, secured pro-
perly and operated.

As soon as allowed to get up, the animal, which was very
lame before, even in walking, showed no lameness, even when
trotted.

The next day, there was swelling of the right fore-arm and
the animal dragged her leg somewhat with difficulty. These

two conditions disappeared rapidly, the wound properly treated
39

40 MEDIAN NEUROTOMY

was cicatrized in less than a month, and at that date the knuck-
ling only remained.

Through peculiar circumstances, the animal was kept at
rest two months and a half. When then the owner came for her,
she was in the same condition, free from lameness. Desirous
to follow her and to know what would be the result after
she had been put to work, I inquired about her, and on the
98th of November, 1892, I was told that “the operation had been
a perfect success ; the mare did not go lame at her full work in trot-
ting, but had remained a club-foot.”

The result was there as perfect as it could be expected, as
long as the knuckling could not be removed.

Since, I have learned that the mare had been sold in
March, 1893, and had brought a good price, after having worked
six months, four of which in the winter, without lameness or
any accident.

This fact is a recovery.

OpsERvVATION II.—Norman mare, 11 years, used for rapid
heavy work, owned by Mr. A.

She was bought to the Alfort Clinic, the 24th of November,
1892; for months she had tendinitis of both fore-legs, upon
which blistering applications had been without results. Both
of her legs were stiff, but the off one, which was the most dis-
eased, was lamer.

In the stable, she rested alternatively upon one leg, then
on the other; the near one more frequently carrying the weight,
as it was the less affected.

Median neurotomy was performed on the right leg, the
26th of November, 1892.

After a few days of rest, the lameness had diminished, and
the immediate effect in action, though quite evident, was not
much marked. On the other hand, it was most shown when
in the stable, as then it was the off leg, the most diseased,

MEDIAN NEUROTOMY 41

which, contrary to what existed before, was able to carry the
weight of the body oftener.

The after results of the operation were very simple, and
the wound cicatrized in fifteen or twenty days.

I tried to find out afterwards what had become of the mare,
and on the 26th of September, 1893, the owner wrote:

“The mare did not go lame on the operated leg; for a
month and a half she had done hard work in snowy weather,
on the pavement of Paris, without showing the least trouble ;
but as she was also affected on the left leg, which caused her to
go lame now and then, and again, as, even before becoming
disabled, she proved too light for her work, she was not
considered worth the expense of a second operation and was
disposed of, to be sold for the butchery.”

My colleague and friend, Mr. Motreff, who had watched
her, wrote in the same sense:

“She performed quite a hard service for a month, free
from lameness on the operated leg. There was. no softening
of the tendons, an accident which you mentioned as possible,
and that notwithstanding the severity of her work: proof of
which is, that she ruptured her tendons in the violent efforts
she made to move very heavy loads. However, the lameness
of the non-operated leg laid her up again, and rather than incur
further expenses, my client:disposed of her. To-day the mare
is dead. But I can assure you that the operation was a success,
and that if in my practice a valuable animal becomes disabled
with tendinitis, I shall have no hesitation to have him oper-
ated.”

Here again is a recovery.

It may be objected that the mare was sold to the butcher.
This sale is sufficiently explained by these letters. As to her
death at the butcher slaughter house, it rust be remembered
that for the public, and especially for dealers, chronic tendinitis
is considered as an affection absolutely incurable, especially

42, MEDIAN NEUROTOMY

when both legs are affected. Those ideas, correct for so long a
time, cannot be eradicated from one day to the other.

OrsErRvATION III.—The 8th of December 1892, at Alfort,
I performed mesoneurectomy upon a bay gelding, for quick
heavy draught, the property of Mr. G., of Paris.

For several months back, the horse had been affected on
the left fore leg with periostosis of the coronet, complicated
with very serious tendinitis and knuckling which gave rise to
excessive lameness; the animal was walking on three legs.

Firing applied on the tendons remained without result.

Immediately after the operation, the animal being exer-
cised trotting, showed but little lameness ; when he was trotted
a second time it was more marked; at a third test, about same
condition, though less marked than before the operation. The
wound made on the sterno-aponeuroticus was probably the
cause of the reappearance of the lameness.

Tn the stable, the animal puts his operated leg freely on

the ground.
Tn from 15 to 20 days the cicatrization of the wound was

complete.

The Ist of January, 1893, when I left the school, the animal
was very little lame.

TI learned since, that towards the end of January, the
lameness was scarcély visible, but that upon the advice of a
veterinarian, the horse had been sold without having been
returned to his work.

I was unable to follow him afterwards. The immediate
sale, upon veterinary advice, did not surprise me very much,
as it will take time before my colleagues will accustom them-
selves to appreciate that in mesoneurectomy they have an
efficacious mode of treatment against chronic tendinitis.

Though this animal was not returned to his work, this case

may be considered as an incomplete recovery or improvement.

MEDIAN NEUROTOMY 43

OxssErvaATIONS LY. and V.—A black heavy draught stailion,
7 years old, belonging to Mr. L., from La Plaine, St. Denis.

He was bought in the month of August, 1892, for one
thousand franes ; after one or two months of work as a shaft-
horse, he became lame on both fore legs with tendinitis. He
worked very little, but yet tlhe lameness increased in severity.
The 13th of March, 1893, he was sent to a farmer to be used
on the farm. Notwithstanding the change and the great
reduction of work, the tendinitis became so painful that the
farmer, towards the end of May, 1893, notified the owner that
it was impossible to keep him any longer, as he had become
entirely unable to do the lightest work. At the same time, the
veterinarian who had taken care of him while at the farmer’s,
informed the owner also that the inflammation of the tendons
was so marked that it was useless to expect anything from
firing, and he advised median neurotomy as the only means to
give him relief.

Returned to his owner the 5th of June, 1893, I examined
him. He was much reduced in flesh, suffered excessively from
both fore-legs, the seat of two tendinites, which, though not
the seat of great tumefaction, are very painful; they are
scarcely touched than by a sudden motion of his legs he indi-
cates the great pain he has felt. In the stable, he alternatively
rests upon one leg and then the other, more frequently, how-
ever, on the right, which is less diseased. The owner, on seeing
the condition of his animal, did not believe in any interference
to cure him, and had decided to’send him to the butchery.
On my insisting, and more to be agreeable to me than with
hope of a favorable result, he consented to have him operated.

On the 10th of June, 1893, I performed mesoneurectomy
upon the left leg, the most diseased. When left to rise, in
walking, as it was impossible to make him trot, the lameness
had disappeared from the operated leg. In the stall, it is on
that leg that most of the weight of the body is carried. The

44 MEDIAN NEUROTOMY

wound healed up rapidly; it was closed in fifteen days, and
then in trotting the lameness had entirely disappeared from
the left operated leg. Suffering only on one side, the condition
of the animal improved ; he had regained flesh.

On the 30th of June, 1893, the operation was performed
on the right leg, and was followed by an immediate and com-
plete removal of the lameness. The cicatrization lasted again
fifteen days, during which the animal was kept at rest ; he then
began to take walking exercise, and by degrees improved more
and more in condition.

Towards July 23d, 1893, he did light work; from the
30th, he did half duty. Every morning, as draught-horse,
he went to Paris and returned, having made, without fatigue,
a distance of 6 or 7 kilometers, pulling a heavy load of refuse
from the city.

Fifteen days later, August 15th, his work became harder;
he went in the country in the afternoon, carrying the dirt from
city streets, and traveled an average of 20 kilometers a day.
The first trips he returned a little tired ; douches, camphorated
alcoholic frictions and one day of rest straightened him once
again.’ At the end of August, he resumed his ordinary work,
the morning in the city, the afternoon in the country. Since
he worked regularly, the leader in a team of four, I did not
allow him to return to the shaft. His driver was most satis-
fied with his work, and would not change him for any other of
the stable, where there are 60 other good animals.

I must say that in August, 1894, one year after resuming
work, some swelling occurred on the left tendon, with a shght
soreness and lameness. Was this due to a blow or a relapse
of the tendinitis? I was unable to decide. It became, how-
ever, necessary to blister the parts, which treatment, with a
rest of 10 or 15 days, relieved the lameness and allowed the
animal to resume his work, which has not been interrupted

since.

MEDIAN NEUROTOMY 45

I was desirous to notice this peculiarity, as it proves that
in case of any inflammation starting on the tendons of a leg
which has been mesoneurectomized, it is possible to blister
that region and thus to relieve the inflammatory process and
also the lameness accompanying it.

The two tendinites, even the left, seem to have diminished,
but yet, as is observed in all operated individuals, they are a
little painful to the touch, a condition due probably in great
part to the sensibility of the skin, which has not been
destroyed by the operation.

These two operations, which constitute two recoveries, are
as complete as possible; I have indeed followed the animal in
question for eighteen months of very hard work, and will still
follow him, as he is yet with the same owner. And again, the
result is yet more perfect, as it shows an animal which was
going to be killed as useless, and which, after having its two
medians divided, performs without lameness an exceptional
work.

The subject of this observation was presented to the
Société Centrale on the 26th of April, 1894, where its condition
and working abilities could be seen.

It is a remarkable, a marvelous recovery ; it is more than that,
it is a resurrection, which by itself is sufficient to give median neurv-

tomy a great practical value and to have it immediately adopted.

OpsERvATION VI.—Very light gray mare, a trotter, 11 years
old, owned by Mr. H., Paris. Since January, 1893, this animal
suffers very much with a tendinitis of the right fore leg; the
services that she renders are insignificant, she is too lame.
Blistering, points firing, gave no result whatever.

Several veterinarians have seen her, and considering her
incurable, advised to have her destroyed. I saw her in the
beginning of January, 1894. The lameness was excessive, even

46 MEDIAN NEUROTOMY

in walking, and mesoneurectomy alone could give her relief.
She was operated on the 13th of that month.

When up from the bed, the mare goes scarcely lame, even
in trotting. In three weeks the wound is healed, and 25 days
after the operation she does light work, easier than before,
entirely free from lameness in walking, imperceptibly so in
trotting.

Afterwards, and up to the beginning of April, she works
quite hard, and what little lameness remained is gradually
passing away. Notwithstanding this result, as she is blemished
by the swelling of her tendons, her owner disposed of her to a
horse dealer, who himself sold her to a farmer.

Having inquired about her, I was written in November,
1894, that she is entirely well, and does an excellent service.

The result is excellent. This case a recovery.

OsservaTion VIJ.—Heavy draught grey stallion, 8 years
old, owned by MM. G. de K. and G. de L., of Paris.

Bought in March, 1893, this animal has on the external
face of the anterior coronet, an exostosis which has grown and
lames him. The lameness not being very severe, he is kept at
work until the end of the year; but at that time, tendinitis
and knuckling complicate the case on the same leg, and he
becomes very lame, even in walking, thus becoming unable to
perform a remunerative work. Consulted in the beginning of
February, 1894, I advised mesoneurectomy, predicting at least
an improvement; that is, the disappearance of the pain due to
the tendinitis, doubting the result on account of the external
periostosis of the coronet.

The operation is done on the 17th of February, 1894. In
getting up, the lameness has almost entirely disappeared, even
in trotting. The wound heals rapidly. I prescribe 15 days of
complete rest, 8 of walking exercise, 8 of light work, and 8 of
half work. The patient resumes his work afterwards, which

MEDIAN NEUROTOMY 47

he does without fatigue, and which consists in pulling every
day, in Paris, 2,000 kilograms. A slight lameness, scarcely
noticeable in trotting, remains; but the horse, entirely useless
before the operation, has now worked without interruption for
the last ten months.

The small lameness, which has not disappeared, is evidently
due to the phalangeal periostosis, existing on the outside of
the coronet, which receives its sensibility through the cubito
cutaneous.

There has then been only tmprovement. The subject was
exhibited before the Société Centrale, the 26th of April, 1894.

OBsERVATION VIII.— The 22d of March, 1894, I had
occasion to operate at Mr. G.’s, of Paris, a brown bay gelding.

The subject has a very serious chronic tendinitis on the
near fore leg, and besides has the fold of the coronet filled with
a hard, thickening tendon; upon all these lesicns are to be
seen lines of firiug, which has been applied without result.
The animal walks much on his heels, and is very lame even in
walking.

Immediately after the section of the median, the lameness
has almost entirely disay peared.

Three weeks after, Mr. G. sold him for 250 francs, whereas
previous to the operation he could not obtain 60 for the but-
chery. I have learned that since he does a good light work in
the City.

He was sold because the administration to which he
belonged could no longer use him on account of the blemishes
of his left fore leg.

The result was therefore very good, and, without fear of
exaggeration, can at least be considered as an improvem-ut.

As Mr. G. gave me this information upon this subject,
he told me that he had just operated upon a horse suffering
wih tendinitis, and that immediately after the operation, the

48 MEDIAN NEUROTOMY

animal was entirely free from lameness. He was sold shortly
after, and having lost sight of him, I am unable to say what

were the results. I did not count him in my observations.

OssERVATIONS IX and X.—A grey heavy draught stallion,
8 years old, property of M. M., from the Plaine St. Denis, is
for the last 18 months suffering with tendinitis of both fore-
legs.

IT had often recommended median neurotomy, but the
owner would not consent to it. In May, 1894, the animal being
unable to perform any duty, I was allowed to operate. At that
time, the tendinites are enormous, very painful and complicated,
with slight knuckling of the left leg, but knuckling to the 3rd
degree on the right. The patient moves only with great diffi-
culty.

The operation is performed the 19th of May, 1894, on both
legs at one time.

When up, after the operation, the walking is very easy;
there is, so to speak, no more lameness; but the movements of
the right leg, which is knuckled very much, remain irregular.

Tn the stable, the anterior biped is even and steady.

The horse has not at all suffered from this double opera-
tion, and the cicatrization of the two wounds has taken place
very fast.

Here I must mention a little incident. There was no
vacant stall for him in the stable, and immediately after the
operation, he was tied up in a coach house where there was
no manger, nor hay-rack. He was obliged to take his food
from the floor; and as a consequence of this, the knucklings,
and principally that of the right leg, had a tendency to become
more marked.

Fortunately, I observed this condition and was able to
bring it to an end, by changing the mode of his feeding.

The animal has been walked and exercised as recom-

MEDIAN NEUROTOMY 49

mended in all these cases. He returned to his work. In
spite of the knuckling of the right leg, which had but improved,
while that of the left had disappeared, the horse was able to
do his duty, free from lameness, while, previous to the opera-
tion, he could not be utilized.

He thus worked for three months, and on account of his
blemish, the knuckling, he was sold to a farmer, who works
him with satisfaction.

Here the results were as complete as they could be, as
there was no hope to remove the blemish of the right leg; and
I register these two observations as fwo recoveries.

OpsERVATION XI.—Very large, grey stallion, 10 years old,
owned by M. D., of Vincy-Manceuvre.

For three years, he has been suffering with tendinitis of
the right fore-leg, which has given rise to quite a bad lameness.
Mr. Delamarre, veterinarian, has fired him twice in points, but
without success. After hearing of the reports I had made
before the Société Centrale, he asked me to come and operate
the lame patient.

The operation was done June the 18th, 1894 ; immediately
after, there was great diminution in the lameness, and a better
standing in the stable.

Since that time, I have received letters from both the
owner and the veterinarian, by which I am informed that the
healing of the wound was very rapid, that the animal is lame
no longer, that after three weeks he had resumed his work as
wheeler of a heavy truck team, that with the exception of a
few days, because of a mild attack of distemper, he has not
stopped working.

In brief, the owner and his veterinarian were very well
satisfied, and state that I am justified in considering this case
as one followed by radical «nd remarkable recovery.

50 MEDIAN NEUROTOMY

OpsERVATION XII.—Heavy draught bay stallion, 7 years,
owned by Mr. G., of Paris.

During June, 1894, he became very lame on the near fore-
leg, which I diagnosed to be caused by an incompleted fracture
of the os corone. Notwithstanding a proper treatment, the
lameness remains very severe on three legs, and periostosis
makes its appearance.

To test the value of mesoneurectomy in similar cases, I
performed it on the 17th of July. When up, the lameness is
considerably reduced : this evident improvement was probably
the result of nervous shock; a few days after the lameness
reappears and remains as severe as before the operation.

The failure is complete.

The 8th of August, 1894,I performed the double high
neurotomy, which was followed by complete success—proving
the correctness of the diagnosis. During that operation I was
able to control interesting facts, mentioned in the indications
for the operation, and which showed that if the internal
plantar nerve was entirely insensible, the external had, on the
contrary, kept almost its normal sensibility.

OBSERVATION XIII.—Very light grey horse, enormous in
size, having cost 1,800 francs, when five years old; is now 12,
and belongs to Mr. de C., of Crépy-en-Valois.

Since the month of March, 1893, this animal, working on |
a farm, has a sprain of the tendons of the off fore leg, which
lames him. The 31st of August, 1893, Veterinarian Congis is
consulted; it is he who afterwards asked me to operate on the
horse, and furnished me with all the information of the case.
On the 2d of September, 1893, he fires the tendinous region.
The lameness subsides some and the animal returns to his
work, which has to be suspended at repeated intervals by half
day's rest. In July, 1894, the lameness is excessive, and the
leg at rest is carried forward of the plumb line to be relieved.

MEDIAN NEUROTOMY 51

Consulted again, the veterinarian recommends median
neurotomy, which I perform the 22d of July, 1894. Once up,
the lameness is as severe as before. On the 25th, there is
great improvement; he walks easily, trots very slightly lame,
and much better than before the operation.

The 6th of August shows him without any irregularity of
action. He receives walking exercise for a week, and is then
put to work in the field.

Since that time, the recovery has remained permanent; as
a wheeler of a heavy truck team, he has carried heavy loads of
beets, a weight (wagon and load) of 5,000 kilograms, and
during this hard work has been used every day, and notwith-
standing the rapidity of the gait he had sometimes to assume,
compelled as he was to follow his younger and more vigorous
leaders.

Mr. Congis, who saw him in November, says that he
noticed nothing wrong about him, except a little induration in
the fold of the coronet; he considers the case a handsome
SUCCESS.

It is a recovery.

OBSERVATIONS XIV anp X V.—Sorrel mare, 14 years old, that
LT bought August Ist, 1894.

She walks with difficulty on the anterior biped, the toes
of both fore feet come first on the ground, while the heels
scarcely reach it.

The tendons, without being tumefied, are a little sensitive
to pressure, indicating a slight tendinitis. There is contrac-
tion of the heels, very painful ascending corns, especially on
the outside. I suspect navicular disease.

She is a worn-out animal, upon which I desire to experi-
ment with mesoneurectomy.

The operation is performet on both legs the 2d of August
1894, Immediately after, the walking is much freer and the

52 MEDIAN NEUROTOMY

resting on the ground firmer. Exploration of the feet shows
that the corns are sensitive only on the outside.

The wounds heal rapidly, and the animal shows no fatigue
from the operation.

Three weeks after, I harnessed her to a light wagon, and
she made about 10 kilometers quite comfortably.

In the first days of September she was sold, and since
does a light service in Paris, a service that she could not have
done before the neurotomy was performed.

IT am quite certain that she would do excellent work in
the country.

There is, then, in this case, only two improvements.

Altogether, the soreness of the tendinitis has disappeared,
but that of the outside corns, and perhaps also of the navicular
disease, remained partly.

OnsERVATION X VI.— Light draught bay horse, property of
M. M., of Crepy-en- Valois.

An enormous periostosis of the right fore fetlock, due to a

aumatic arthritis, following a wound made by a pitchfork,
has given rise to a very marked lameness.

Mr. Congis had fired the diseased part with penetrating
points, on the 25th of February, 1892, and on tke 30th of Sep-
tember a temporary improvement had followed, and the
horse was able to do a light picking up service.

In August, 1894, the lameness is very severe; the animal
walks on three legs and the owner thinks of having him killed,
when Mr. Congis calls me to perform median neurotomy.

It is done August 9th, 1894. When up, the lameness is as
marked as before.

Later on, a comparative improvement takes place.

I am informed on the 8th of November that the lameness,

MEDIAN NEUROTOMY 53

though not entirely removed, has considerably diminished, and
the horse can be utilized again about the farmhouse.
There is only an improvement.

OBsERVATION XVII.—Sorrel mare, Angio-Norman, trotter,
belonging to Mr. Congis, veterinarian, at Crépy-en- Valois.
It was he who neurotomized her, and in November, 1894,

sent me the following information °
“T bought this mare having an old periostosis of the left

fore fetlock. She could make 5 leagues and a half an hour

without whip, and trotted beautifully. On several occasions, I
treated her, and, with a great deal of care, I had succeeded in

making her travel every day over a more or less long distance,
when in July, 1894, she became quite lame. She was fired with
deep points, producing good effects, but this did not remove
the lameness. On the 9th of September, 1894, I, with my
assistant, mesoneurectomized her. The immediate result was
excellent. Exercised walking and trotting, immediately after
the operation, she went perfectly sound. It is important to
state that the periostosis of the fetlock had become very large,
and that it had produced a marked deviation of the phalangeal

lever.
“These two experimental tests (Observation XVI) prove

that mesoneurectomy is an operation not to be ignored in cases
of periostosis of the fetlock, and that it must be preferred to
firing.

“My mare was put in harness in the first days of October,
and could trot nearly as fast as before her lameness. No
lameness now, even at this fast gait; one of our colleagues has

witnessed this.
“T sold the mare on account of the size of the ugly

\

periostosis.”
This observation can be considered as a recovery.

54 MEDIAN NEUROTOMY

OpsERvATION XVIII.—Dark bay mare, 13 years old, be-
longs to a cab company in Paris.

For several years back, she suffered with a periostosis of
the right fore fetlock, for which she was fired several times.
Now and then, she is laid up for a few days.

Tn October, 1894, she became lame, but the lameness now is
persistent, and she had been laid up so long that on the 3rd
of November, at all risks, I performed median neurotomy.

When up from the bed of operation, the lameness had
entirely disappeared, even in trotting. I was quite surprised
at the result, being then ignorant of those of the two preced-
ing observations, and having to help me in my prognosis of a
similar case, only the negative result of the horse for experi-
ment (see the indications above mentioned), with the immediate
effects, also negative, of Observation XVI.

The wound healed rapidly, and what soreness resulted
from the inflammation following the operation, had subsided
toward the 18th of November.

On the 25th of that month, she was put in harness and
does a short call, free from lameness.

After all of the indicated necessary after cares had been
taken, she was put back to her service on the 5th of December,
and has worked ever since without going lame.

This fact is a recovery.

OxsEervations XIX and XX.—Bay mare, aged 8 years,
belongs to a cab company of Paris.

On the 16th of December, 1894, I performed median neu-
rotomy on the two legs at one time, which were affected with
chronic tendinitis. The mare, which was for a long time unable
to work, was stiff in the anterior biped, but principally lame in
the right leg.

Immediately after the operation, she trotted with much
more freedom, and there was no more lameness,

MEDIAN NEUROTOMY 55

Towards the first of January, 1895, she began to return to
harness; since she has made several short calls, walking or
trotting.

In the latter end of the month, Iam sure she will be able
to resume her ordinary work; consequently, I count here again
two recoveries.

In consulting these 20 observations, one ‘will see that
mesoneurectomy employed against chronic tendinitis, has
given me 11 recoveries in 11 cases; against tendinitis with
diseases of the fetlock, 5 improvements out of 5 cases; against
periostosis of the fetlock, 2 recoveries: and one improvement
out of 5 cases; and against ring bones, one failure out of one
case.

These facts confirm plainly my opinions upon median
neurotomy, as well as the conclusion closing the first part of
this article.

My colleague and associate, M. Nigon, in whose presence
and with whose assistance I performed some of these opera-
tions, the good results of which he has been able to observe,
thinks as I do, that mesoneurectomy, opposed to chronic ten-
dinitis and periostosis of the fotlock, constitute a real surgical
progress.

APPENDIX

In the Revue Vétérinaire for November, 1895, published at
the Veterinary school of Toulouse, Mr. J. Sendrail, adjunct to
the Chair of Clinical Surgery, writes :—

“Though it is ten years since Peters, of Berlin, made this
operation known, and notwithstanding the writings, already
numerous, of Goldmann, Moller, Baldoni, Pellerin, Blanchard
and others, it is not yet generally known. It deserves, how-
ever, to enter on the domain of our surgery, where it is
called to render great services.

“When, some months ago, T presented to the readers of
the Revue Vétérinaire the pamphlet of Mr. Pellerin upon this
question, I abstained from any remarks as to the operation
itself, as the number of observations I possessed was too small
to justify me in giving an opinion. Since then I have taken
advantage of every opportunity that presented itself to perform
median neurotomy, and I consider it my duty to mention the
results obtained. I also believe it to be useful to my readers
to give a resumé of the principal data necessary to know how
to perform the operation and to deseribe the modes of opera-
tion I have adopted.

“ Indications. — Median neurotomy, according to some

authors, has so many indications that it is a true panacea
against all causes of chronic lameness of the anterior ex-
tremities. But exaggerations of too enthusiastic authors must

always be carefully put aside in all new discoveries.
36

MEDIAN NEUROTOMY. 57

“This operation cannot possess such general effects, and
among the cases against which it has been recommended, some
are absurd, inefficacious and useless.

“ Absurd, as in cases of shoulder lameness. This needs
no discussion, and the results claimed by those who give this
indication cannot be explained except by an error of diagnosis.

“Unefficacious, when the articulations are mechanically
stiffened by anchylosis or extensive periostosis.

“Useless, in cases where plantar neurotomy is sufficient,
such as navicular disease, side and ring bones. In these cases,
I believe it is better to have recourse to plantar neurotomy,
as, harmless as mesoneurectomy is, it is better not to remove
the sensibility in such extensive regions without necessity.

“Tf, then, it is true that the operation can render service
in the treatment of various chronic affections of the lower
regions of the fore-legs, it is only really advantageous in a
small number of them. But if we consider the serious
nature of those affections and the inefficacy of the other modes
of treatment used against them, the importance granted to
median neurotomy and the praises given to it are well justified.

“The principal indication of this operation is indeed
chronic tendinitis. And, knowing how many horses are
disabled by this alteration of the tendons, or one of its com-
plications, most unavoidable, knuckling, and also how we are
almost powerless in their presence—actual cauterization,
tenotomy, etc., giving, at least generally, only temporary and
illusory results—it is evident that mesoneurectomy very
happily comes to complete the resources of surgical thera-
peutics.

“There is also another indication to which I desire to call
attention: it is the persistency or the recurrency of lameness
of navicular disease after plantar neurotomy. This operation
is and must remain still the treatment of predilection against
that disease ; but it may be insufficient, the section of one of

58 MEDIAN NEUROTOMY

the branches of the nerves may not remove entirely the sensi-
bility of the foot, and the lameness remains. In this case,
neurotomy above the fetlock not being entirely free from
danger, one way remains, upon the efficacy of which one can
depend: that is, the neurotomy of the median.

“This operation can also be very useful in cases, com-
paratively frequent, in which, several months or even years
after plantar neurotomy, the lameness of navicular disease
returns. In such occurrence, all that we could do was to try
to remove the nervous cicatrices, extirpate the neuromata; but,
besides the fact that this was always a more or less difficult
thing to do, the return of the lameness may have several other
causes, escaping this surgical intervention.

“Thus we have two serious affections, chronic tendinitis
of the suspensory apparatus of the fetlock and rebel navicular
disease, against which we were completely powerless, and
against which mesoneurectomy becomes at last a defensive
process. These two affections may exist on the same leg. It
is known, in fact, that painful diseases of the feet and those of
long standing are often complicated with tendinitis and
knuckling. Median neurotomy then becomes truly precious,
permitting as it does to remedy at the same time the primitive
and casual lesion, and also the secondary consecutive, no less
serious.”

Place of Election.—Operation.—These are not different from
those laid down in the first part of this work, the same general
rules being followed. by both writers.

Results.— Speaking of these, Mr. Sendrail continues :—

“Immediately after the operation, the animal carries
weight on his operated leg as well as the sound one, he points
no longer; and if the lameness still continues for a few days
it ordinarily disappears with the sweliing consecutive to the
traumatism. All my operated patients have returned to
light work fifteen days or three weeks after the operation ; but

MEDIAN NEUROTOMY 59

. for some time to come they use their diseased leg with less
tacility, and are more apt to stumble.

“ Applied rationally, mesoneurectomy gives results more
constant, and generally sufficiently complete to render to the
operated ones all their value as working animals.

“From my own observations, median neurotomy applied
against chronic tendinitis has always been followed by
removal of the lameness.

“ Altogether, that is the essential result, the one looked
for most commonly, as it allows the utilization of a disabled —
animal. But I have obtained more of this operation, as I have
seen, with horses seriously knuckled, the fetlock was partly
straightened and even resumed its proper position.

“This result is explained by the loss of sensibility of
organs, insensible in their normal condition, that had acciden-
tally become sensitive from the inflammation.

“So as not to apply upon these organs painful strains, the
animal bends its fetlock forward. As mesoneurectomy sup-
presses this pathological sensibility, the horse presses freely
upon his tendons and the fetlock returns in its backward
position, as much as it is allowed to do so by the length still
preserved by its suspensory supports. Count must, indeed, be
taken of the definitive shortening that those may have under-
gone in serious tendinitis, shortening which fixes, without
remedy, the fetlock in its abnormal position.

‘Recovery or only improvement of knuckling, should not
be considered as a constant effect of median neurotomy ; but,
as it has been observed, it must be mentioned. In two cases,
principally, the fetlock became straightened in a much appre-
ciable measure; in a third, the knuckling had altogether
disappeared.

“This last observation is worth reporting. It was a large
Breton horse, 11 years old, used to heavy work, dragging
railroad cars, which necessitates violent efforts, When I saw

60 MEDIAN NEUROTOMY.

him, the 21st of last March, he had been lame for five months
with a severe tenositis of the reinforcing band of the perforans
(localization not uncommon in heavy draught horses); this was
on the right fore leg. He was very lame and unable to do any
work. At rest, the diseased leg is always carried forward.
Pressure on the tendon is very painful. There is knuckling
at the second degree. Blistering applications and lines
cauterization have failed to give any results.

“ Mesoneurectomized the 22d of March, he leaves the
hospital the 4th of April, free from lameness and the fetlock
much straightened. A few days after, he resumes his hard
work and fulfils it to his owner’s satisfaction. Two months
after the operation, the deviation of the fetlock has entirely
disappeared, and the diseased leg does not differ from the
other, except by the large size of the tendon. _

“ Against navicular disease, old and rebel, median neu-
rotomy has also given me good resullis; as example, I present
the following case:

“A Tarbian mare, 10 years old, had, two years ago, low
plantar-neurotomy performed on the left anterior leg. She
continued to go tender, but yet has been able to do her work.
For three months back, her lameness has increased. Median
neurotomy is done on the 23d of June, and ten days after, she
has recuperated all her previous gait.

“T have spoken on the indications for mesoneurectomy of
cases where navicular disease was complicated with tendinitis.
Here is a typical subject : |

“An aged mare has had, four years ago, low plantar-
neurotomy performed on both fore legs for navicular dis-
ease. The lameness disappeared, but returned again some
four or five months ago, much more severe, and as a con-
sequence, very serious tendinites developed themselves on
both legs.

“The entire region of the tendons is considerably swollen

MEDIAN NEUROTOMY. 61

,and very painful to the touch. The animal walks with
difficulty, and can scarcely stand on her fore legs.

“The 31st of May, I performed mesoneurectomy on the
left leg. Immediately after the operation, the operated leg is
alone able to carry the weight of the body, the right is still
carried forward. ‘Twelve days later, the owner takes her away
and refuses to consent to the expenses of the second operation.
To-day she is stiil very lame on the right fore leg.

“These examples are sufficient to show the importance of
the services that median neurotomy can render. This opera-
tion must then be «onsidered as classical, and as one that ail
practitioners shall often heve opportvaity to perform with
profit and honor.”

WILLIAM R. JENKINS’
CATALOGUE

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the external and internal Parasites—vegetable and
animal—which attack various species of Domestic
Animals. A Treatise by L. G. Neumann, Professor
at the National Veterinary School of Toulouse,
Translated and edited by George Fleming, C. B., L.L.
D.,F.R.C.V.S. 873 pages, 365 illustrations, cloth.7 50

()FRIEDBERGER-FROHNER. “Pathology
and Therapeutics of the Domesticated Animals.”
By Dr. Friedberger. Translated by Prof. W. L. Zuill,
Ma DE VeNs . 2 Woliks ccs ceces Rapid tsledie gale Sc 12 00

GRESSWELL. ‘The Diseases and Disorders of the
Ox.” By George Gresswell, B.A. With Notes by
James B. Gresswell. Crown, 8vo, cloth, illus....3 50

GRESSWELL. ‘Diseases and Disorders of the
Horse.” By Albert, James B., and George Gresswell.
Crown, 8vo, illustrated, cloth.....- Se she ewes vewe 1 75

8 veterinary Catalogue of William R. Jenkins

GRESSWELE, Manual of “The Theory and Practice
of Equine Medicine.” By J. B. Gresswell, F.R.C.V.S.,
and Albert Gresswell, M.R.C.V.S., second edition,
enlarged, Sv0; Cloths ewmctrenusleehie's oak ieee 2 75

GRESSWELL. ‘Veterinary Pharmacology and
Therapeutics.” By James B. Gresswell, F.R.C.V.S.
16mo;cloth.2ees 28 ee acess ee ee EES 1 50

GRESSWELL. ‘The Bovine Prescriber.” For the
use of Veterinarians and Veterinary Students. By
James B. and Albert Gresswell, M.R.C.V.S Cloth.75

GRESSWELL. ‘The Equine Hospital Prescriber.”
drawn up for the use of Veterinary Practitioners and
Students. By Drs. James B. and Albert Gresswell,
MOB OVS. © Clothe: 2. since. = « tala sin le eee 75

GRESSWELL. “Veterinary Pharmacopeia, Materia
Medica and Therapeutics.” By George and Charles
Gresswell, with descriptions and physiological actions
of medicines. By Albert Gresswell. Crown,8vo,cl. 2 75

(*“\GOTTHEIL, ‘A Manual of General Histology.”
By Wm. S. Gottheil, M.D., Professor of Pathology in
the American Veterinary College, New York; etc., ete.

Histology is the basis of the physician’s art, as
Anatomy is the foundation of the surgeon’s science.
Only by knowing the processes of life can we under-
stand the changes of disease and the action of remedies;
as the architect must know his building materials, so
must the practitioner of medicine know the intimate
structure of the body. To present this knowledge in
an accessible and simple form has been the author's
task. 8vo., cloth, 148 pages, fully illustrated.,, 1 00

851-853 Sixth Avenue (cor. 48th St.), New York. 9

*\HASSLOCH, ‘A Compend of Veterinary Materia
Medica and Therapeuties.” By Dr. A. C. Hassloch,
V.S., Lecturer on Materia Medica and Therapeutics,
and Professor of Veterinary Dentistry at the NewYork
College of Veterinary Surgeons and School of Compa-
rative Medivine, N. Y. 12mo, cloth, pages..

HAYES. ‘Veterinary Notes for Horse-Owners.” An
every day Horse Book, Jllustrated. By M. H. Hayes.
1nvo: Cloths ook cats Led weatavaen here sie aictatatete cuera ata e oie 5 00

HAYES. “Riding.” Onthe Flat and Across Country.
A Guide to Practical Horsemanship. By Captain M.
H. Hayes. Second edition, 16mo, cloth......... 4 25

HAYES. ‘Illustrated Horse Breaking.” By Captain
M. H. Hayes. 12mo, cloth, illustrated.......... 8 40

HAYES. ‘The Horsewoman.” By Captain M. H.
Hayes and Mrs. Hayes. 12mo, cloth, illustrated.4 25

HEATLEY. ‘The Horse Owner’s Safeguard.” A
handy Medical Guide for every Horse Owner. 12mo,
Pa MIEN cto ai=\ sta Rctere td) bcuindea sieletess Shale 58% ce ve 1 50

HEATLEY. “Practical Veterinary Remedies.”
IAT. OUT Een econ AS CURE DOAD COD CRC Ceri esc er 1 00

(HEATLEY, ‘The Stock Owner’s Guide.” A
handy Medical Treatise for every man who owns an
ox orcow. By George S. Heatley, M.R.C.V. 12mo,
CITI tions Sa cotton Good COS S GEO OOD CONE Cone aneeaas 1 25

HILL. ‘The Principles and Practice of Bovine Med-
icine andSurgery.” By J. Woodroffe Hill, F.R.C.V.S.
Cloth. (Temporarily out of print),

10 Veterinary Catalogue of William R. Jenkins

HILL. ‘The Management and Diseases of the Dog.”
Containing full instructions for Breeding, Rearing and
Kenneling Dogs. Their Different Diseases. How to
detect and how to cure them. Their Medicines, and

the doses in which they can be safely administered.
By J. Woodroffe Hill, F.R.C.V.S. 12mo, cloth, extra
fully illustrated «2.30259 2. cs went Rees tee Cree 2 00

HINEBAUCH. ‘Veterinary Dental Surgery.” For
the use of Students, Practitioners and Stockmen.

(**)HOARE. ‘A Manual of Veterinary Therapeutics
and Pharmacology.” By E. Wallis Hoare, F.R.C.V.S.
12mo, cloth, 560 pages..........sseeer sees eeeees 2 75

“Deserves a good place in the libraries of all veterina-
rians. * * * Cannot help but be of the greatest assist-
ance tothe young veterinarian and the every day busy
practitioner.”—American Veterinary Review.

(*,KOBERT. ‘Practical Toxicology for Physicians
and Students,’”? By Prof. Dr. Rudolph Kobert,
Director of the Pharmacological Institute, Dorpat,
Russia. Translated and edited by L. H. Friedburg,
Ph.D:, of Dept. of Chemistry, College of City of New
York, Prof. of Chemistry and Toxicology at the Ame-
rican Veterinary College, New York, and New York
Homcepathic Medical College and Hospital. Author-
ized edition. (Jn Press.)

KOCH. * Etiology of Tuberculosis.” By Dr. R.
Koch. Translated by T, Saure, 8vo, cloth,,..,1 00

851-853 Sixth Avenue (cor. 48th St.), New York. 11

KEATING. ‘A New Unabridged Pronouncing
Dictionary of Medicine.” By John M. Keating, M.D.,
LL.D., Henry Hamilton and others. A voluminous
and exhaustive hand-book of Medical and scientific
terminology with Phonetic Pronunciation, Accentu-
ation, Etymology, ete. With an appendix containing
important tables of Bacilli, Microcci Leucomaines,
Ptomaines; Drugs and Materials used in Antiseptic
Surgery; Poisons and their antidotes; Weights and
Measures; Themometer Scales; New Officinal and
Unofficinal Drugs, etc., etc. 8 vo, 818 pages..... 5 00

LAMBERT. ‘The Germ Theory of Disease.”
Bearing upon the health and welfare of man and the
domesticated animals. By James Lambert, F.R.C.V.S.
PRRMUING neg Soto Anco eee Casa eR ae write eed 5 25

LAW, ** Farmers’ Veterinary Adviser.”? A Guide to
the Prevention and Treatment of Disease in Domestic
Animals. By Professor James Law.Illustrated. 8vo,

LIAUTARD. ** Animal Castration.” A concise and
practical Treatise on the Castration of the Domestie
Animals. The only work on thesubject inthe English
language. Illustrated with forty-four cuts. 12mo,
cloth ..... Mf eae te esi orc si ait arses idle sits oc ar cishe Ga eet 2 00

(*)LIAUTARD. ‘Median Neurotomy. ” 8vo,
SUL e a ANN, 2 OS eles arc ia ake Sorta bes cele 1 OV

LIAUTARD. ‘*Vade Mecum of Equine Anatomy.”
By A. Liautard, M.D.V.S. Dean of the American Vet-
erinary, Coilece,. 12m0, Cloth: i556 bcos oe ees vs 2 00

12 ~=Veterinary Catalogue of William R. Jenkins

LIAUTARD. ‘Translation of Zundel on the
Horse's: Boot.?"+ (Cloth:+:23: 22t eae 2 v0

LIAUTARD. ‘How to Tell the Age of the Domestic
Animal.’? By Dr. A. Liautard, M.D., V.S. Profusely
illustrated: LT2mo; (cloth: wo. sce ome eee nae 50

LIAUTARD. **Qn the Lameness of Horses.’’? By
As Tiiaatard,. Mi Di Vimescanensicece coe eee 2 50

C)LIAUTARD,. ‘Manual of Operative Veterinary
Surgery.” By A. Liautard, M.D., V.M., Principal
and Professor of Anatomy, Surgery, Sanitary Medicine
and Jurisprudence in the American Veterinary College;
Chevalier du Merite Agricole de France, Honorary
Fellow of the Royal College of Veterinary Surgeons
(London), ete., etc. 8vo, cloth, 786 pages and nearly
GOO UWMUStratlOnsenie cis ces ciao Hise lene emesis 6 00

LONG. “Book of the Pig.” Its selection, Breeding,
Feeding and Management. 8vo, cloth........... 4 25

()LUPTON. ‘Horses: Sound and Unsound,” with
Law relating to Sales and Warranty. By J. Irvine
Lupton, F.R.C.V.S. 8vo, cloth, illustrated...... 1 25

LUPTON. ‘*The Horse.” As he Was, as he Is, and
as he Ought to Be. By J. I. Lupton, F.R.C.V.S. Illus-
trated.. (Crown; GVO" eects cs secures 2 eine mareiaae 1 40

MAGNER. ** Facts for Horse Owners.” By D.
Magner. Upwards of 1,000 pages, illustrated with 900
engravings. 8vo, cloth, $5.00; sheep, $6.00; full
MOTOCCOs; J. 3's pores ete oe ee tele > Pe rity (fa)

851-853 Sixth Avenue (cor, 48th St.), New York. 18

MAGNER. ‘Veterinary Diagrams.” (1) The Struc-
ture of Horses Feet (in colors). The Structure of
Horses Feet (Effects of Bad Treatment of the Feet).

Mounted and Varnished.................s.0.% ...2 00
(2) The Shoeing of the Horse. The Education of the

Horse. Mounted and Varnished................ 2 00 -

MAYHEW. ‘**The Illustrated Horse Doctor.” An
accurate and detailed account of the Various Diseases
to which the Equine Race is subject ; together with the
latest mode of Treatment, and all the Requisite Pre-
seriptions written in plain English. By E. Edward
Mayhew, M.R.C.Y.S. Illustrated. Entirely new
BOUTON OVO CLO Ulm. care tarelsistslateetsivtetelevers aos aise Sin s/s 2 75

McBRIDE. ‘Anatomical Outlines of the Horse.”
VATS CLOL Me ertetetee tars ciao tie ache S x gtd etclaiadate'e a cletete crea = 2 50

McCOMBIE. ‘Cattle and Cattle Breeders.” Cloth.1 00

M’FADYEAN. ‘Anatomy of the Horse.” A Dis-
section Guide. By J. M. M’Fadyean, M.R.C.V.S.
This book is intended for Veterinary students, and
offers to them in its 48 full-page colored plates numer-
ous other engravings and excellent text, the most
valuable and practical aid in the study of Veterinary
Anatomy, especially in the dissecting room. vo,
COLLEY ay feet rere Vases ChaletAye oils" a) sie stale cw a) 5:6 seein oS Fie clever aus 5 50

M’FADYEAN. ‘**Comparative Anatomy of the
Domesticated Animals.’”?> By J. M’Fadyean, Pro-
fusely illustrated, and to be issued in two parts. Part
I—Osteology, ready. Paper, $2 50; cloth....... 275

(Part II. in preparation.)

14 feterinary Catalogue of William R. Jenkins

MILLS. ‘How to Keep a Dog in the City.’ By
Wesley Mills, M.D,V.S. It tells how to choose
manage, house, feed, educate the pup, how to keep him
clean and teach him cleanliness. Paper........... 25

(*)MOLLER. “Operative Veterinary Surgery.” By
Professor Dr. H. Moller, Berlin. Translated and
edited from the 2d edition, enlarged and improved,
by John A, W. Dollar, M.R,.C.S.

Prof. Moller’s work presents the most recent and
complete exposition of the Principles and Practice of
Veterinary Surgery, and is the standard text-book on the
subject throughout Germany.

Many subjects ignored in previous treatises on
Veterinary Surgery here receive full consideration,
while the better known are presented under new and
suggestive aspects.

As Prof. Moller’s work represents not only his
own opinions and practice, but those of the best
Veterinary Surgeons of various countries, the trans-
lation cannot fail to be of signal service to American
and British Veterinarians and to Students of Veter-
inary and Comparative Surgery.

1 vol., 8vo. 722 pages, 142 illustrations ........ 5 25
MORETON. ‘* On Horse-breaking.” i2mo, cl...50

MOSSELMAN-LIENAUX., “Veterinary Microbio-
logy.” By Professors Mosselman and Liénaux, Nat-
ional Veterinary College, Cureghem, Belgium. Trans-
lated and edited by R. R. Dinwiddie, Professor of
Veterinary Science, College of Agriculture, Arkansas
State University. 12mo, cloth, 342 pages........ 2 50

851-853 Sixth Avenue (cor. 48th St.), New York. 15

(*)NOCARD. ‘The Animal Tuberculoses, and their
Relation to Human Tuberculosis.” By Ed. Nocard,
Professor of the Alfort Veterinary College. Trans-
lated by H. Scurfield; M.D. Ed., Ph. Camb.

Perhaps the chief interest to doctors of human
medicine in Professor Nocard’s book lies in the
demonstration of the small part played by heredity,
and the great part played by contagion in the propa-
gation of bovine tuberculosis. It seems not unreason-
able to suppose that the same is the case for human
tuberculosis, and that, if the children of tuberculosis
parents were protected from infection by cohabitation
or ingestion, the importance of heredity as a cause of
the disease, or even of the predisposition to it, would
dwindle away into insignificance. 12mo, cloth. 143

PEGLER. ‘The Book of the Goat.’? 12mo, cloth.1 75

PELLERIN. ‘Median Neurotomy in the Treatment
of Chronic Tendinitis and Periostosis of the Fetlock.”’
By C. Pellerin, late repetitor of Clinic and Surgery to
the Alfort Veterinary School. Translated, with Addi-
tional Facts Relating to It, by Prof. A. Liautard, M.D.,
Velin coMo soOnTdss WlUStratedians «ives sae stase: 1 00

PROCTOR. ‘The Management and Treatment of
the Horse” in the Stable, Field and on the Road.
ys Walliam, ProcuOrer SVOsJ coh. oe secede des - 2 40

PETERS. ‘A Tuberculous Herd—Test with Tuber-
culin.” By Austin Peters, M.R.C. V.8., Chief
Inspector of Cattle for the New York State Board of

.. Health during the.winter of 1892-93,. Pamphlet, .,.26

16 Veterinary Catalogue of William R. Jenkins

REYNOLD. “Breeding and Management of Draught
Horses.” ‘BVONGLOUn: 3273... Pane ce ee ee 1 40

ROBERTSON. “The Practice of Equine Medicine.”
A text-book especially adapted for the use of Veter-
inary students and Veterinarians. By W. Robertson,
Principal and Professor of Hippopathology in the
Royal Veterinary College, London. 8vo. cloth, 806
pages; Tevised sedition... ooce aace eee eee eee 6 25

(MROBERGE, ‘The Foot of the Horse,” or Lame-
ness and all Diseases of the Feet traced to an Unbal-
anced Foot Bone, prevented or cured by balancing the
foot. By David Roberge. 8vo, cloth........... 5 00

(“)SMITH., **A Manual of Veterinary Physiology.”
By Veterinary Captain F. Smith, M.R.C.V.S. Author
of “‘A Manual of Veterinary Hygiene.”

Throughout this manual the object has been to con-
dense the information as much as possible. The
broad facts of the sciences are stated so as to render
them of use to the student and practitioner. In this
second edition—rewritten—the whole of thé Nervous
System has been revised, a new chapter dealing with
the Development of the Ovum has been added together
with many additional facts and illustrations. About
one hundred additional pages are given. Second
edition, revised and enlarged, with additional illus-
UWatlons: <.%..-h<.6 FR iwidibiae ht telole Cwm eeeeac Ain eape tee eave 3 75

-(*)SMILH, “Manual of Veterinary Hygiene,? 2nd
edition, revised, Orown, 8V0, ClOtN weyrrrerry eed 2B

851-8538 Siath Avenue (cor. 48th St.), New York. 17

STORNMOUTH. ‘Manual of Scientific Terms.”
Especially referring to those in Botany, Natural
History, Medical and Veterinary Science. By Rev.
VANIGS SLOLMMOUbDe esis elcistsisisieciets ine leis lsictatalavahcaaeeo) OO

(*)STRANGEWAY. “Veterinary Anatomy.” New
edition, revised and edited by I. Vaughn, F.L.S.,
M.R.C.V.S., with several hundred illustrations. 8vo.

()SUSSDORF. Colored Plates specially for Lectures.
Size 40x27. By Professor Sussdorf, M.D. Translated
by Prof. W. Owen Williams, of the New Veterinary
College, Edinburgh. Plate 1.—Diagram of the Horse
(left or near side view). Plate 2.—Diagram of the
Mare (right side view). Showing the position of the
viscera in the large cavities of the body.

SHIGE; UMMOUNLOUS. «2 sc caceren «Se ose oeee eas 1 75 each
s¢ mounted on linen, with roller...1 75 extra ‘

** Anatomy of the Cow” (in preparation).

VETERINARY DIAGRAMS in. Tabular Form.
Size, 284 in. x 22 inches. Price per set of five... .4 75

No.1. “The External Form and Elementary Ana-
tomy of the Horse.” Eight coloured illustrations—
1. External regions ; 2. Skeleton ; 3. Muscles (Superior
Layer); 4. Muscles (Deep Layer); 5. Respiratory Ap-
paratus; 6. Digestive Apparatus; 7. Circulatory Ap-
paratus ; 8. Nerve Apparatus ; with letter-press descrip-
tion

No. 2. ‘*The Age of Domestic Animals.” Forty-two
figures illustrating the structure of the teeth, indicat-
ing the Age of the Horse, Ox, Sheep, and Dog, with
ful] deseription SHCCe ing Ol Monee rae cee re ee

18 Veterinary Catalogue of William R. Jenkins

No. 3. ‘The Unsoundness and Defects of the Horse.”
Fifty figures illustrating—l. The Defects of Confor-
mation; 2. Defects of Position ; 3. Infirmities or Signs
of Disease ; 4. Unsoundnesses; 5. Defects of the Foot;
wilh full’ deserip tion. cistcir seis, teehee eee tee tee 75

No. 4. ‘The Shoeing of the Horse, Mute and Ox.”
Fifty figures descriptive of the Anatomy and Physio-

fol

logy of the Foot and of Horse-shoeing. ........... 75

No. 5. ‘The Elementary Anatomy, Points, and But-
cher’s Joints of the Ox.” Ten coloured illustrations
—1l. Skeleton; 2. Nervous System: 3. Digestive
System (Right Side); 4. Respiratory System ; 5. Points
of a Fat Ox; 6. Muscular System; 7. Vascular System;
8. Digestive System (Left Side); 9. Butcher’s Sections
of a Calf; 10. Butcher’s Sections of an Ox; with full
descriptions. /.o sere 'te cleie Since < tier ees SOL 1 25

WALLEY. ‘Hints on the Breeding and Rearing of
Farm Animals.” 12mo, cloth.......... ee soar 8U

WALLEY. ‘ Four Bovine Scourges.” (Pleuro-Pneu-
monia, Foot and Mouth Disease, Cattle Plague and
Tubercle.) With an Appendix on the Inspection of
Live Animals and Meat. Illustrated, 4to, cloth..6 40

WALLEY. “The Horse, Cow and Dog.” By Dr.
Thomas Walley. A poetical account of the ‘‘ Troubl-
ous Life of the Horse”; ‘‘ The Life of a Dairy Cow,”
and ‘The Life of a Dog”; with an article on Animal
Characteristics, 12mo0, Gloth, ..wesrer cere erey ee BO

851-853 Sixth Avenue (cor. 48th St.), New York. 19

C)WALLEY. ‘‘A Practical Guide to Meat Inspection.”
By Thomas Walley, M.R.C.V.S., formerly principal
of the Edinburgh Royal (Dick) Veterinary College ;
Professor of Veterinary Medicine and Surgery, ete,
Third Edition, thoroughly revised, with forty-five
coloured illustrations, 12mo, cloth............... 3 00

An experience of over 30 years in his profession
and a long official connection (some sixteen years)
with Edinburgh Abattoirs have enabled the author to
gather a large store of information on the subject,
which he has embodied in his book. Dr. Walley’s opi-
nions are regarded as the highest authority on Meat
Inspection.

(*) WILLIAMS. “Principles and Practice of Veter-
inary Medicine.” New author’s edition, entirely
revised and illustrated with numerous plain and color-
ed plates. By W. Williams, M.R.C.V.S.8vo., cl..6 00

(**)WILLIAMS. ‘Principles and Practice of Veter-
inary Surgery.” New author’s edition, entirely
revised and illustrated with numerous plain and
colored plates. By W. Williams, M.R.C.V.S. 8vo,

ZUNDEL. ‘The Horse’s Foot and Its Diseases.” By
A. Zundel, Principal Veterinarian of Alsace Lorraine.
Translated by Dr. A. Liautard, V.S. 12mo, cloth
RULES ET ah Use tere cravenevetereraise ert as creyeeis.” «o/s ot) steusiein $2 2 00

ZUILL. ‘Typhoid Fever; or Contagious Influenza
in the Horse.” By Prof. W. L. Zuill, M.D.,D.V.S.
Para Inleiemeptee Wiens) fae ne essere [elec 2 aie slote nis 3 sol aes ve as 25

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