The second case concerned a woman, aged twenty-nine, with convulsive movements of the trapezii dating back seven years. Resection of both spinal accessory nerves at the posterior border of the sternomastoid was practised on November 21, 1892; consecutive double trapezius paralysis revealed the fact that the deep rotators of the head on either side were similarly in a state of spasm; on December 13, 1892, the posterior branches of the first, second, and third left cervical roots were divided by Keen's method, the contractions being now confined to the deep rotators of the right side, which were to be treated in their turn in the same manner. Comment is needless. In a case of spasm of the left sternomastoid and certain muscles of the neck reported by Chipault,[207] bilateral removal of the superior cervical sympathetic ganglion was followed by instantaneous relief, succeeded by a relapse and a second cure; a degree of retrocollic spasm persisted. Kocher's plan of cutting successively all the muscles affected has given varying results, according to de Quervain. This procedure has been adopted by others, notably by Nové-Josserand[208] in a case where treatment by suggestion had proved of no avail. For some days after the operation the spasm was exaggerated, although it eventually disappeared. It is permissible, however, to doubt the definite and radical nature of these cures if we look at the long catalogue of admitted operative failures. Linz's two cases[209] of resection were unsatisfactory. In Popoff's experience[210] tonic muscular spasm returned in spite of repeated neurectomies, in contradistinction to the notable improvement he accomplished by simple re-education. Tichoff[211] found the torticollis reappear four days after division of the spinal accessory, and though, in his opinion, relapse supervenes after this operation in more than fifty per cent. of cases, he expresses himself in favour of further operative interference. Two of Dalwig's patients developed a functional torticollis to avoid the diplopia caused by a superior strabismus. Ocular tenotomy, as might have been foreseen, was quite ineffectual in checking the tic; indeed, the author himself seems to have been well aware of the necessity, in curing such vicious habits, of influencing the attention. He proceeds to emphasise the hopefulness of orthopædic, as opposed to surgical, treatment, and recommends the use of a cardboard collar, though any benefit thus derived is, in our experience, purely ephemeral.