CAUDAL MYOTOMY 233 



through the same perforation and releasing the tail from its 

 position over the back. 



Third Step. — Haemostasis. — The bleeding, unless its ar- 

 rest is immediately provided for, is always copious. The 

 operation can, however, be made perfectly bloodless by 

 keeping the tail stretched over the back (in which position 

 the wound will not bleed) until the bandage is applied, and 

 in the interest of neat surgery this should always be the aim, 

 in distinction to allowing blood to gush out over the buttocks 

 and hind extremities while preparation is being made to ap- 

 ply the haemostatic bandage. The safe bandaging of the tail 

 at this point, where its diminishing diameter favors slipping, 

 is effected by twisting the end of the bandage into a loose 

 cord and passing it around the tail once or twice at the seat 

 of section, where it will imbed itself between the divided 

 ends of the muscles and thus effectually lock itself against 

 slipping downwards. The bandage is wrapped tight but is 

 removed two hours afterward. on account of the danger of 

 inflicting injury. 



When it has been decided to "pulley" the tail the bandage 

 is superfluous, as the stretching of the tail upwards will con- 

 trol the bleeding sufficiently, if not absolutely.. If after the 

 tail has been thus elevated the bleeding seems rather copious 

 or persistent, the addition of more weight to the pulley-cords 

 for an hour or two will generally control the situation satis- 

 factorily. When the cutaneous incision has been accident- 

 ally made rather large and thus operates to favor bleeding, 

 the edges may be closed with a short pin held in place with 

 a thread, figure eight fashion. 



AFTER-CARE. — The after-care of the patient is of cap- 

 ital importance, in that the success of the operation depends 

 entirely upon preventing reunion of the divided muscles. 

 The continuity must be permanently destroyed to assure per- 

 manent results. If no provision is made to prevent reunion 

 a cicatrix is promptly interposed between the cut ends and 

 the function of the muscle is soon fully restored. To pre- 

 vent reunion the following methods are recommended 



i. Daily, beginning the day following the operation, the 

 tail is carefully but firmly pushed over the back and the 

 thumb is pressed forcibly into the space between the cut 

 ends, forcing the contents of the cavity out through the 

 small cutaneous wound. Thus on the first day the cavity is 

 rid of its coagulum which would have aided in the construc- 

 tion of the connective union, and during - the subsequent 

 twelve days the repeated pressing out of the secretions and 



