i 4 o APPLIED ANATOMY. 



called the thoracic duct ; it begins as the receptaculum chyli on the body of the 

 second lumbar vertebra and is about 45 cm. (18 in.) long. It drains all the left side 

 of the body and the right as far up as and including the lower surface of the liver. 



The duct on the right side is called the right lymphatic duct ; it is only i or 2 

 cm. in length and drains the right side of the head and neck, tlie right upper ex- 

 tremity, and the right side of the chest as far down as and including the upper surface 

 of the liver. 



TORTICOLLIS OR WRY-NECK. 



In this affection the head and the neck are so twisted that the face is turned 

 toward the side opposite the contracted muscle and looks somewhat upward. It is 

 usually caused by some affection of the sternomastoid muscle. It is not always the 

 only muscle involved, as the trapezius and others may likewise be affected. It is 

 congenital or acquired. In the congenital cases it is caused by an injury to the 



FIG. 170. Torticollis or wry-neck. 



sternomastoid muscle, occurring during childbirth; a swelling or tumor may be 

 present in the course of the muscle. In the acquired form the distortion may be 

 more or less permanent and may be due to caries or other disease of the spine. In 

 such cases it is evident that treatment is to be directed to the diseased spine rather 

 than to the sternomastoid muscle. 



Inflammation of the lymph-nodes of the neck may cause the patient to hold the 

 head and neck in a distorted position. The wry-neck in this case will disappear as 

 the cause subsides. Rheumatic affections of the neck are a common cause, and the 

 sternomastoid muscle may then become contracted and require division. In rare 

 instances a nervous affection causes a spasmodic torticollis. The persistent move- 

 ments render this a very distressing affection, and to relieve it not only has the 

 sternomastoid but also the trapezius been divided, and even the spinal accessory and 

 occipital nerves have been excised. 



Division of the sternomastoid muscle should be done by open and not by sub- 

 cutaneous incision. The sternal origin of the sternomastoid muscle is a sharp, dis- 

 tinct cord, but its clavicular origin is a broad, thin band extending outward a third of 

 the length of the clavicle. An incision 2 or 3 cm. or more in length is made over 

 the tendon and the bands are to be carefully isolated before being divided. The 

 structure most important to avoid is the internal jugular vein. It lies close behind 

 the sternal origin of the muscle and great care must be taken to avoid it. In one 

 case in which it was accidentally wounded it was necessary to ligate it. As the 



