WRY-NECK. 



nolis can be made, when the bones are originally concerned 

 ill the produftion of a wry-neck, muft depend upon the 

 nature and degree of the morbid afFeftion of thofe parts. 



In the treatment of a wry-neck, we muft endeavour to 

 foften and relax the contrafted mufcles, and ftrengthen 

 thofe which are ftretched and tenfe. Tne firft indication, 

 Jorg thinks, may be fulfilled by the ufe of oily emollient 

 liniments two or three times a day ; the fecond by the em- 

 ployment of fpirituous ftimulating embrocations. When 

 common applications of the lart kind are unavailing, we are 

 advifed to ufe fpirit of ammonia, tindlure of cantharides, 

 &c. It is alfo neceffary to perfevere for a long time in 

 thefe remedies, even though the fl<in may become red and 

 tender. Jorg is an advocate likewife for applying com- 

 prelfes to the parts dipped in fuch ftimulating fluids, and 

 kept conftantly wet with them. Thus he calculates on 

 maintaining the effefts of their operation without interrup- 

 tion. 



If the complaint be confijerable in degree, and the head 

 and neck much diftorted, we are advifed to combine with 

 the foregoing means what are termed manipulations, which 

 confift in manual endeavours to obtain an elongation of the 

 contrafted mufcles, efpecially the fterno-cleido-maftoideus. 

 In thefe manoeuvres, we are direfted to rnb with one hand 

 the mufcle upwards, and at the fame time to try to move 

 the head in the fame direftion. With the other hand we 

 are to bring the head into it3 natural pofition, and keep it 

 there, fo that the contrafted mufcles may be extended as 

 much as polfible. The greater their fpafmodic contraftion 

 is, the more muft we rub them in the direftion above 

 fpecified, even as long as a quarter or half an hour at a 

 time ; and the plan muft be repeated once, twice, or thrice 

 a day, until the head will remain quite ftraight, or until 

 that fide of the neck, which was previoufly convex, has 

 become concave, and vict verfa. Befides thefe manipula- 

 tions, the head and face fhould be moved together into a 

 perfectly upright pofture, laterally, and efpecially towards 

 the fide to which they could not be turned, owing to 

 the contrafted ftate of the mufcles. By thefe means, the 

 patient will foon acquire the faculty of moving the neck to 

 one fide, which muft always be a defideratum in the treat- 

 ment. 



Profeflbr Jorg fays, he has not deemed it necefiary to 

 mention eleftricity and galvanifm as remedies, which may 

 be joined with thofe above recommended. Whoever likes 

 to try them, however, (liould only apply them to thofe 

 niufcles which are in a ftate of tenfion ; for every ftimulus 

 muft be improper for fuch as are contrafted. 



This author does not fay much in favour of the warm 

 bath as a remedy for wry-necks, in which cafes he owns 

 he has never made trial of it. All his patients have been 

 children from one to nine years of age ; and he thinks it 

 would have been difficult, and even dangerous in fome cir- 

 cumftances, to have immerfed them fufficiently in the warm 

 water to cover their necks. Thefe are the only reafons 

 which he gives for not having tried fo important a remedy 

 for the wry-neck as the warm bath. 



One of the principal means for the cure of a wry-neck 

 confifts in a mechanical apparatus, by which the head is 

 brought into a ftraight pofition, the contrafted mufcles are 

 elongated, and others, which are on the ftretch, kept in a 

 ftate of reft and relaxation. It may be faid, indeed, that 

 the patient ftiould be able to put his head and neck in this 

 pofture himfelf, and that no mechanical apparatus is re- 

 quifite. But fuch pofture can only be adopted by making 

 a great effort, and even then imperfeftly. Hence the belt 

 inclined patients foon give up the attempt, and the head 



becomes depreffed agaiu. For children who cannot be per. 

 fuaded to obferve regularly the defirable pofition, the 

 apparatus is more eflential than for many adults. Several 

 other writers had entertained this opinion previoufly to pro- 

 fefl^or J5rg. Kohlers, Bernftein, and other authors, re- 

 commend a variety of mechanical contrivances for the cure 

 of the wry-neck. None of thefe, however, have anfwered 

 the expeftations of profefTor Jorg, who has felt himfelf 

 called upon to make an invention of his own. In the con- 

 ftruftion of his machine, he went upon the following prin- 

 ciples : I. That its operation fhould be effefted by 

 means of a fpring. 2. That the aftion of the ftretched 

 enfeebled fterno-cleido-maftoideus fhould be ftrengthened, 

 and the equilibrium between it and its fellow thereby 

 re-eftabhfhed. 



The apparatus confifts of a leather pair of ftays, and of 

 a band or fillet which goes round the head. On the centre 

 of the fore-part of the ftays is a kind of pulley, or wheel, 

 which admits of being turned to the right or left, and then be- 

 comes fixed by meansof a fpring. From this apparatus a band 

 proceeds up the patient's neck to the fillet, placed round the 

 head, and to which it is faftened direftly behind the ear, clofe 

 to the maftoid procefs. This band lies in the fame direftion 

 as the lengthened fterno-cleido-maftoideus mufcle, and when 

 drawu towards the breaft by the wheel, it produces 

 the fame effeft as would arife from an incraafe of ftrength 

 in the aftion of that mufcle. _ In fliort, it pulls the maftoid 

 procefs downwards and forwards towards the ftemum, 

 counterafts the influence of the oppofite mufcle of the 

 fame name, and thus reftifies the pofition of the head. 



But this band, fays profefTor Jorg, does not merely draw 

 down the fide of the head which is too elevated, it alfo 

 tends to put the neck in a ftraight pofition. It was above 

 explained, that a wry-neck is always more or lefs twifted, 

 in confequence of the contraftion of one of the fterno- 

 cleido-maftoidei, and thus the mouth does not lie in a direft 

 line perpendicularly above the centre of the fternum, but 

 to one fide of this point. The aftion of the preceding 

 band, by drawing forwards as well as downwards towards 

 the middle of the breaft, the maftoid procefs evidently 

 tends to counteraft the effeft produced by the wrong 

 aftion of the faulty mufcle of the oppofite fide. 



ProfefTor Jorg makes his patients wear the apparatus 

 day and night, and he does not even take it off when the 

 friftions are made. The band is to be tightened and 

 regulated according to the effefts produced. Particular 

 care, however, muft be taken not to make it too tight at 

 firft. 



When by perfeverance in the ufe of this apparatus, and 

 the other means above recommended, the neck has been put 

 into a pjoper pofition again, it ufually happens that the 

 head itfelf continues inclined too much forward ; an effeft 

 which the contrafted fterno-cleido-maftoideus, and its anta- 

 gonift the band, both tend to promote. Something, there- 

 fore, muft be done for the alleviation of this defurmity. 

 With this view, Jorg removes the above band from the 

 breaft, carries it under the arm, and through a ring at the 

 fide of the leather ftays or corfets, and thence to the fillet 

 round the head, where it is faftened in the lani' place as 

 before. In this manner, the head will be confiderably 

 elevated, while ftill the objeft of counterafting the fhortened 

 fterno-cleido-maftoideus of the oppofite fide is not negkfted. 

 The ring hinders the band from hurting the axilla, and 

 keeps it from following the motions of the fhoulder. The 

 preceding author lets his patients, towards the latter part of 

 the treatment, wear the apparatus in this way a long while ; 

 yet fometimcs he applies it in both modea alternately, with 



a defiga 



