A treatise on orthopaedic surgery / by Royal Whitman.

  • Royal Whitman
Date:
1904
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on orthopaedic surgery / by Royal Whitman. Source: Wellcome Collection.

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    the movements of the head are carried out in special joints and are controlled by special muscles. Disease at this point is especially dangerous, because displace- ment or fracture of the weakened vertebree may cause sudden death by pressure on the vital centres. Occipito-axoid disease is uncommon, and it is relatively more frequent in adult life than in childhood. Symptoms. Ina typical case the symptoms are neuralgic pain radiating over the back and sides of the head, following the dis- tribution of the auricular and occipital nerves. The neck is stiff and the head may be fixed in the median line, the chin being somewhat depressed, but it is more often tilted to one side, simu- lating the attitude of torticollis (Wig. 24). The attitude and appearance of the patient, when normal move- ment of the neck is restrained by a painful disease, is character- istic; the eyes follow one, or the body is turned, when the attention of the patient is attracted. The patient moves carefully, in order to avoid jar; often the chin is instinctively supported by the hand, and a favorite attitude is one in which the patient sits with the elbows on a table, the hands supporting the head (Fig. 25). If the attempt is made to raise the chin, or to rotate the head, the patient seizes the hands of the examiner, and, it may be, screams in apprehension. There may be slight bulging and thickening of the tissues at the seat of disease. The affected vertebree are usually sensitive to direct pressure, and not infre- quently deep fluctuation in the suboccipital triangle can be made out. The atlo-axoid junction lies just behind the posterior wall of the pharynx, on a line with the upper teeth. Here abscess often presents itself, occasionally early in the course of the disease, causing symptoms characteristic of obstruction, such as snoring, change in the quality of the voice, difficulty in swallowing, or spasmodic attacks of so-called croup. When abscess is present and when the disease is at all acute, the reclining posture some- times aggravates the symptoms, so that ‘‘ getting the child to bed ’’ is often a tedious and difficult task. In certain cases one can determine whether the disease is of the occipito-atloid or of the atlo-axoid articulation, but, as both joints are to a great extent controlled by the same muscles, this is often impossible. The uppermost joint, that between the atlas and occiput, per- mits the nodding movement of the head, or flexion and extension
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