Spasmodic torticollis more particularly has tested the surgeon's sagacity and talent. Yet in the ever-increasing number of recorded cases there is usually a curious indefiniteness of statement on a point of primary importance: was surgical aid sought for the treatment of a tic, or of a spasm? Torticollis tic--mental torticollis--is a psychical disease pure and simple, which does not enter the province of surgery, while torticollis spasm--spasmodic wryneck--may come within the scope of the surgeon's knife, though only on condition that the irritative lesion be sharply localised. Now, not only is this information generally missing, but even more frequently perhaps a hard and fast line between the two cannot be drawn. The wisest course would be to delay the adoption of a plan of treatment whose results are so problematical, but these considerations have unfortunately been outweighed by the operator's laudable desire and expectation of ensuring respite from a most painful affliction. It is purposely to demonstrate how invalid this plea must henceforth remain that we shall now pass rapidly in review the various surgical devices imagined for the relief of torticollis tics and spasms. The first methods to be practised were elongation, ligature (Collier), section (Gardner and Giles), or resection, of the spinal accessory. The last of these was performed for the first time by Campbell in 1866, then by Southam, Mayor, Collier, Pearce Gould, Edmond Oxen, Appleyard, Atkins, etc. Eliot[202] was convinced of the value of this measure, and made a special study of the technique. Coudray[203] recognised the insufficiency of section or resection of the accessory, yet decided in its favour. In the present state of our knowledge (he says), the treatment to be preferred for spasmodic torticollis is resection of the external branch of the accessory. Its superiority over the multiple and successive divisions of the neck muscles vaunted by Kocher--apart from the absence of proof that the latter is more efficacious than the simpler operation--is based on the view that, as the dependence of the condition on cerebral lesions and its occurrence in nervous individuals render uncertain the accomplishment of a complete cure in every instance, with such a class of patient it is essential to have recourse to an operative minimum. In nearly every case, nevertheless, marked amelioration ensues on this procedure, the benefit derived from it forming its thorough justification. If the advantages of such an operation are not more appreciable, we must take up a position of much greater reserve regarding its suitability, particularly in view of the fact that the prosecution of a line of treatment absolutely devoid of risk may assure equally, if not more, satisfactory results. The next step was to devote attention to the cervical nerves.