WRY-NECK. 



quently congenita), and then we need not fpecify any occa- 

 fional caufes. The evil, though it exifts at the time of birth 

 only in a trivial degree, afterwards quickly increafes, and 

 foon becomes ferioua. The regular equilibrium between 

 the fterno-cleido-maftoidei may likewife be deftroyed, when 

 one of them is wounded, or completely cut through ; 

 when it remains pretematurally weak, in confequence of 

 having been the feat of abfceffes, and previous ulceration ; 

 or when, from any caufe whatfoever, its aftion is rendered 

 either too feeble or too powerful. 



In one patient cured by profefTor Jbrg, it is alleged that 

 the inner portion of the left ftemo-cleido-maftoideus was in- 

 ferted into the middle and right fide of the fternum, in the 

 fame place as the inner portion of the mufcle of this name 

 on the right ; and the above author conceived, that this 

 preternatural attachment was probably the caufe of the 

 inclination of the head to the right fide. 



Profeffor Jorg does not give much credit to the opinion, 

 that the wry-neck is frequently brought on by a contraftion 

 of the flcin of the neck and of the platyfma myoides ; the 

 firft of thefe parts being very yielding, and the fecond very 

 thin and elaftic. But, he thinks, that when thefe parts, or 

 any other mufcles of the neck, are (hortened and fpafmodi- 

 cally contrafted, it is generally as a confequence of the 

 affeftion of the fterno-cleido-maftoideus, which is the part 

 originally difordered. 



The fame writer will not deny alfo, that the malformation 

 of the bones may be the firft caufe of this infirmity. If, 

 fays he, the dorfal and lumbar vertebra are liable to curva- 

 ture, why fhould the cervical ones not be fo, and thereby 

 deftroy the equilibrium between the mufcles of the neck ? 

 Yet, he thinks, the caufe of the diforder muft lie much 

 more rarely in the bones than the mufcles, fince he has never 

 feen one iiftance of it. He admits alfo, that there can be 

 no doubt that the bones fooner or later fliare in the effefts 

 of the difeafe ; that they become bent to one fide, and even 

 cemented together by anchylofis. 



As in every other diforder, the praftitioner muft en- 

 deavour to find out the original caufe of the complaint ; 

 and, therefore, the queftion arifes, how can it be known 

 whether the mufcles and the integuments, or the bones, are 

 the firft caufe of the deforniiby ? The caufe may be afcribed 

 to the mufcles, when there is obvioudy fomething wrong 

 about them ; when they are hard and contrafted on one fide, 

 and foft and little prominent on the other ; and when thofe 

 which are {hrunk and ftiortened become ftiU harder and more 

 painful, on putting the head in a Itraight pofition, to the 

 doing of which they alfo make more or lefs refiftance. We 

 may be more certain of the thing, when no difeafe of the 

 bones in any part of the body, and no caufes of fuch com- 

 plaint, can be detefted ; for when the bones are about to 

 foften, or are already foftened, the latter affeftion muft be 

 preceded by certain occafional caufes, and accompanied 

 with the ufual fymptoms. The difcovery of thefe, accord- 

 ing to profeffor Jbrg, is not difficult to the praftitioner, at 

 leaft not impofflble. The diforder, on the other hand, may 

 be referred to the bones, when no particular defeft about 

 the mufcles is apparent, when they are no where remarkably 

 hard and contrafted, and when the cafe is attended with 

 fymptoms and veftiges of a partial or general foftening of 

 the bones. When this is the cafe, the mufcles are ufually 

 much left altered than when they conftitute the original 

 caufe of the deformity ; and the head can be more eafily 

 raifed, turned, and moved about. 



Another queftion is, what degree has the diforder al- 

 ready attained, and have the bones materially participated 

 in the aftedion or not ? Perhaps the cervical vertebrx are 



II 



anchylofed ? Although it may at firft feem eafy to anfwer 

 thefe queftions, yet it is not always fo eafy. The prognofis 

 and treatment, however, are to be regulated by the deci- 

 fion ; and we can never fpeak fatisfaftorily of the cafe, 

 unlefs we have inquired into the whole of its progrefs. 



When the bones are affefted, that is to fay, when in con- 

 fequence of the wrong pofture of the neck a change has 

 taken place in their form ; when they, as is moft ufual, on 

 the fide towards which the head is inclined, are lower thai 

 on the other ; or when their procefles are diminifhed or 

 abforbed ; the praAitioner can frequently feel and fee that 

 the defeft lies in the texture of the bones. The depreffions 

 thus produced may fometimes be plainly feen, or, at all 

 events, can be felt with the finger. When the head and 

 neck are put into the right pofition, thefe depreffions be- 

 come ftin more obvious, as well as the alteration of the 

 fpinous proceffes. In order to derive from fuch examina- 

 tion any precife knowledge, we muft indeed be well ac- 

 quainted with the anatomy of the neck. Profeffor Jorg 

 then gives us fome directions how to move the head and 

 neck, and how to place our fingers in trying to afcertain 

 whether the cervical vertebrae are anchylofed. We pafs 

 thefe over, becaufe we place very little confidence in their 

 accuracy or utility. 



The profeffor next notices the influence which the de- 

 formity has over the whole organization of the body. 

 An imperfeftion in the formation of the head is the firft 

 and principal effeft derived from the infirmity. In cafes of 

 wry-neck, he has never feen the face and head altogether 

 well conftrufted. The half of the face which was neareft 

 to the contrafted fterno-cleido-maftoideus was always 

 {mailer, and lefs prominent, than the other. Frequently 

 the lower jaw, the zygoma, and the eye, were more funk 

 on this fide than the other, and hence the countenance pre- 

 fented a very diftorted emaciated appearance. The fore- 

 going author has alfo conftantly found the raifing of the head, 

 and other motions of this part, materially prevented. The 

 patients always ftoop to one fide in a moft awkward kind 

 of pofture. None of them can turn their heads well. 

 Whenever they want to look laterally, they are obhged to 

 turn their whole bodies. Hence many of them become 

 difqualified for certain occupations, and even if they are 

 capable of work, they labour with more difficulty than other 

 perfons. The preternatural dragging downward of the 

 head, and the curvature of the cervical vertebrae, one would 

 think (fays profeffor Jorg) would have a bad effeft on the 

 funftions of the brain and fpinal marrow. He has, how- 

 ever, never feen this happen ; but on the contrary, in the 

 worft forms of the complaint, he has not found tlie brain at all 

 affeded. Still he does not venture to conclude that things 

 are always fo. Our limits oblige us to pafs over fome other 

 remarks on the preceding topic, in order to begin the 

 confideration of the method of treatment. 



We find then that the wry-neck moftly arifes from an 

 affeftion of the mufcles, and efpecially from irregular action 

 in the fterno-cleido-maftoidei, the equilibrium between which 

 is deftroyed : hence the treatment is generally direfted 

 againft the mufcles, particularly thofe above-mentioned. 

 It is feldom that it is neceffary to do any thing for the 

 bones. For this reafon, the prognofis is generally favour- 

 able, and this the more fo the younger the patient is, and 

 the more yielding the contrafted fterno-cleido-maftoideus 

 happens to be found. Indeed, when the patient is farther 

 advanced in life, and not more than twenty-five or thirty 

 years of age, we fiiould not totally defpair of being able to 

 render nffiftance, if no anchylofis exift, and not too much 

 deformity of the cervical vertebrae. What kind of a prog- 

 nofis 



