Barker, An Interesting Neuritis. 113 



about five inches long from the occipital protuberance down- 

 ward, about one inch to right of median line and parallel with 

 the spine. The transverse processes of the cervical vertebrae 

 were layed bare. Free hemorrhages greatly obscured the field 

 of operation. 



A peculiar condition of the nerves existed. All were en- 

 larged and there was great hyperaesthesia. The Great Occipi- 

 tal nerve was probably twice its natural size and gave evidence 

 of long continued inflammation. 



Although the patient was profoundly anaesthetized, when- 

 ever a nerve was touched there was marked muscular contrac- 

 tion. Sections of the Great Occipital and all the posterior 

 branches of the cervical nerves were exercised at their points of 

 exit from the spinal column. 



Using the index finger as dissector, all the muscles were 

 raised to the line of the ear and nerves freely excised wherever 

 found. Notwithstanding the very extensive wound and free 

 bleeding the patient made a rapid and uneventful recovery. 

 When he sat up, to the intense disappointment of the patient 

 and operator we found the head drawn over and a narrow bun- 

 dle of the anterior fibres of the Trapezius stood out above its 

 atrophied and paralyzed neighbors like a small rope. 



For the third time under my direction the patient was an- 

 aestetized and a section over an inch in length was cut from the 

 centres of the offending group of muscles. The ends retracted 

 and I allowed a mass of blood to accumulate, hoping that the 

 clot would prevent reunion of the muscles. This probably 

 unique operation was successful. Rapid recovery followed. 



After several weeks we found the head feebly drawn to the 

 right. An apparatus was then made with a supporting mast at 

 the back of the neck and passing around beneath the chin and 

 occiput. Formerly no form of apparatus would control the 

 spasms and the patient was compelled to lie down every half 

 hour to avoid the terrible paroxysms of pain. 



He left the hospital wearing the brace and able to sit or 

 walk for an indefinite time, only growing weary sooner than 

 usual. There was undoubtedly a low form of inflammation in 



