CAUDAL MYOTOMY 235 



bygone days, and on account of its cruelty, should be dis- 

 countenanced. 



UNILATERAL CAUDAL MYOTOMY FOR LAT- 

 ERAL INCURVATION. — Technique.-* The depressor 

 muscle on the side toward which the tail is deflected is di- 

 vided as in the bilateral operation. It is important here to 

 pass the tenetome far enough upward to include every shred 

 of the muscle, otherwise permanent results will not be ob- 

 tained. The elevator muscle on the same side is then di- 

 vided by passing the tenetome beneath it from the median 

 line of the superior surface, or from the middle of the lat- 

 eral surface. To assure against immediate reunion the tail 

 is then tied around to the opposite side for a period of ten to 

 fourteen days. 



The secrets of successful intervention are to divide 

 every particle of the muscles, and to operate as near to the 

 root of the tail as possible. 



Note.- — The incurvation is sometimes located some dis- 

 tance from the root of the tail, and not infrequently it tran- 

 scribes a double curve the shape of an S. Such abnormalities 

 are more difficulty to correct, and may require two or three 

 operations before a straight carriage is obtained. The first 

 operation should always be performed at the root of the tail, 

 and after the healing process is complete, the location of sub- 

 sequent sections of the muscles is decided upon by the loca- 

 tion of the remaining incurvation. Sometimes 'the section is 

 made eight, twelve, fifteen or even eighteen inches from the 

 root, and in the case of double incurvation it may be found 

 necessary to operate also upon the opposite side, after the 

 first one has healed. 



SEQUELS AND ACCIDENTS.— (i.) Haemorrhage. 

 — Caudal myotomy sacrifices the lateral coccygeal arteries, 

 which yield a copious bleeding if provision to control the 

 flow is not immediately executed. When the cutaneous 

 puncture has been accidentally made too large to hold the 

 coagulum, stretching the tail in the pulleys may not imme- 

 diately arrest the flow, and if the addition of more weight to 

 the ropes proves unsuccessful, a temporary bandage may be 

 required, but in no case must the bandage be left on more 

 than two or three hours. 



(2) Secondary haemorrhage is the most^common sequel 

 of the operation. It occurs after the bandage has been re- 

 moved, and as the bandage may be reapplied to arrest it, 

 strangulation of the circulation terminating in gangrene, 

 multiple abscesses, diffuse alopecia, or even death, may en- 



