[153] Gross, _Surgery_, 6th ed. vol. ii. p. 736. [154] Holmes's _Surgery_, vol. iv. p. 392. [155] See Miller's _Practice of Surgery_, p. 212. [156] Solly's _Surgical Experiences_, pp. 537, 538, etc. [157] _The Immediate Treatment of Stricture._ By Bernard Holt, F.R.C.S. London. Third Edition, 1868. [158] Holmes's _System of Surgery_, 1st ed. vol. iv. p. 403. [159] Diagram of puncture of the bladder:--B, bladder; SP, symphysis pubis; SC, scrotum; _b_, bulb; _pr_, peritoneum; P, prostate; R, rectum; S, sacrum and coccyx. [160] _Med. Chir. Trans._, vol. XXXV. [161] Diagram of operation for phymosis:--_a_, glans penis; _b b_, mucous membrane exposed by retraction of the skin, and slit up; _c d_, sutures introduced and ready to be tied, uniting the skin and mucous membrane. [162] To illustrate Teale's operation:--_c_, section of penis _b_, thread inserted uniting mucous membrane and skin; _a_, thread tied. [163] _Med. Times and Gazette_, vol. xix. p. 354. [164] Miller's _System of Surgery_, p. 1255. [165] Miller's _System of Surgery_, p. 1256. CHAPTER XIII. TENOTOMY. For convenience' sake I group under this one head certain operations used for the relief of distortion, in which muscles or tendons are divided subcutaneously. Since the discovery of the principle by Delpech, and the application of it by Stromeyer, Dieffenbach, Little, and countless successors, it has been used for very many cases for which it is totally inapplicable, _e.g._ for the division of the muscles of the back in spinal curvature. Still there remain several deformities for the relief of which subcutaneous tenotomy is a most important remedy; chief among these are Wry Neck and Club-foot. OPERATION FOR WRY NECK.--_Subcutaneous section of the sterno-mastoid._--In what cases of wry neck is this operation suitable? In those only in which the muscles are the starting-point of the mischief. These are sometimes congenital, more frequently they commence in childhood. In cases where the distortion depends on disease of the cervical vertebræ, or is secondary to curvature of the spine, division of the muscle is worse than useless. _Operation._--A tenotomy knife, which should be sharp-pointed, narrow in the blade, with a blunt back, should be introduced through the skin a little to one side of the sternal portion of the affected muscle, passed along with its flat edge between the skin and the tendon, till it has fairly crossed the tendon; the blade should then be turned so that by a gradual sawing motion the edge may be made to divide the tendon about an inch above the sternum. A distinct snap will then be felt or heard, and the position of the head will be at once much improved. Exercise, warm bathing, and rubbing, will generally suffice to complete the cure, without it being necessary to call in the aid of the instrument-maker with his expensive apparatus.[166]