142 SURGICAL APPLIED ANATOMY. [Chap. ix. 



extensive development, producing the diffused liporaa 

 known as " double-chin." 



The skin over the nape of the neck is very dense 

 and adherent, a,nd these two circumstances, in addition 

 to the free nerve-supply of the parts, serves to explain 

 the severe pain that often accompanies inflammation 

 in this region. Common carbuncle is very commonly 

 met with at the root of the neck, in the middle line. 

 Why it especially selects this spot it is difficult to 

 say. It may be noted, however, that this region has 

 no very extensive blood supply, that the middle line 

 of the body is in all parts of comparatively slight 

 vascularity, and that at the nape of the neck 

 covered and uncovered parts of the body meet, so 

 that the spot is liable to considerable fluctuations 

 of temperature. Setons and issues were, in less 

 recent times, often applied to the dense integuments 

 at the back of the neck, just below the occiput. 

 These measures were accredited with not infrequently 

 producing tetanus, and, in such cases, it is probable 

 that the nerve irritation started in the great occipital 

 nerve. 



When the steriio-mastoid muscle of one side is 

 rigidly contracted, either from paralysis of the opposite 

 muscle or from spasmodic contraction, or from some 

 congenital defect, the condition known as wry-neck is 

 produced. The position of the head in wry-neck 

 illustrates precisely the effect of the sterno-inastoid 

 when in full action. The head is bent a little 

 forwards, the chin is turned towards the sound 

 side, and the ear on the affected side leans towards 

 the sterno - clavicular joint. In many cases the 

 trapezius and scalene muscles are also affected. 

 Spasmodic contraction of the muscle may be due 

 to reflex iiTitation. Thus, it has accompanied inflam- 

 mation of the cervical glands in the posterior triangle. 

 Such inflammation has irritated some brandies of thp 



