354: DISEASES OF THE PERIPHERAL NERVES. 



in this way, while in others it is said to disappear when dentition is 

 complete. 



Tonic spasm of the accessory nerve of Willis is the cause of the 

 spastic form of torticollis or caput obstipum. The spasm is usually 

 confined to the sterno-cleido-mastoideus, so that the head is inclined 

 forward and downward. The affection occurs more frequently in chil- 

 dren than in adults, and perhaps, too, it sometimes affects the foetus 

 if congenital torticollis be attributable to an intra-uterine foetal tonio 

 spasm of this muscle. Sometimes the tonic spasm is preceded by a 

 brief attack of clonic convulsions ; more generally, however, the muscu- 

 lar contraction is of a tonic character from the first. At the com- 

 mencement the disease is apt to be considered of little moment, and, 

 as it is usually attended by pain, is looked upon as of rheumatic char- 

 acter. An embrocation of opodeldoc is ordered for the " stiff neck," 

 or else some other equally harmless prescription. Finally, however, 

 the obstinacy of the attack and its gradual aggravation furnish evi- 

 dence of its more serious nature. The head is drawn more and 

 more to one side, the sterno-mastoid muscle of that side, particularly 

 its sternal portion, stands out like a hard cord, while upon the up- 

 turned side of the neck the skin is stretched and the muscles are not 

 prominent at all. If the disease last long, the face becomes distorted, 

 the hypertrophied muscles drawing their corresponding half of the face 

 downward. In the same way the permanent obliquity of the attitude 

 often leads to curvature of the spine, and to sinking of the thorax of 

 the affected side. 



TREATMENT. Treatment of clonic spasm of the spinal accessory 

 nerve is seldom very successful. It is true that Moritz Meyer, in five 

 sittings, completely cured a soldier affected with tic convulsif and 

 clonic spasm of the neck, by faradizing each one of the contracted mus- 

 cles. The negative results, however, which I myself as well as others 

 have witnessed in the treatment of tic convulsif, by faradization and 

 galvanism, would imply that such brilliant cures were exceptional. 

 So, too, the internal use of sulphate of zinc, and of carbonate of iron, 

 and the application of moxas to the back of the neck, would seem to 

 have sometimes been of service. Section of nerves has not succeeded, 

 although, in two cases, division of the muscles was successful. In a 

 third case, in which the division of the muscles was practised more 

 than once, no benefit was derived. 



We can give no rules for the treatment of the salaam convulsion, 

 since the nature of this affection, and especially its etiology, is entirely 

 unknown. The treatment of tonic spasm, which belongs to the prov- 

 ince of orthopedic surgery, can boast of some success in cases which 

 were not of too long standing. 



