in the nerve mechanism of the affected muscles--most
probably in their cortical centres. It would appear that in some cases
the spasmodic jerkings are originated by certain movements habitually
made by the patient in the course of his work. In others, as a result
of astigmatism and other errors of refraction, the patient has
acquired the habit of repeatedly tilting his head to enable him to see
clearly, and these movements have become continuous and
uncontrollable.

The affection tends to become progressively worse until the patient is
incapacitated for work or enjoyment. Sleep even may be interfered
with.

_Treatment._--In well-marked cases the use of drugs, electricity, or
restraining apparatus is never curative, but these measures combined
with massage have been temporarily beneficial in milder cases.

Of the operative procedures, resection of portions of the accessory
nerve on one side, and of the posterior primary divisions of the first
five cervical nerves on the opposite side, seems to offer the best
prospect of recovery. Simple division of these nerves or resection of
the accessory alone has not proved permanently curative. Open division
of the offending muscles without interfering with the nerves has given
good results, and is a much simpler operation (Kocher).

Spasmodic wry-neck must be distinguished from the #hysterical#
variety, which after lasting for weeks, or even months, may pass off
completely, but, like other hysterical affections, is liable to recur.

Deviations of the neck simulating torticollis may occur in cervical
caries, and in unilateral dislocation of the spine.

The #cicatricial contraction# of the integument of the neck that
results from extensive burns, abscesses, or ulcers, may cause
unsightly deformity and fixation of the head in an abnormal attitude,
and call for surgical treatment. The contraction which follows the
disappearance of a gumma of the sterno-mastoid may also produce a
deformity resembling wry-neck.

INJURIES

#Contusion# of the neck may result from a blow or crush, as, for
example, the passage of a wheel over the neck, or from throttling,
strangling, or hanging. In medico-legal cases the distribution of the
discoloration should be carefully noted. When due to throttling, the
marks of the fingers may be recognisable, and nail-prints may be
present. In cases of strangling, the mark of the cord passes straight
round the neck, while in suicidal hanging it is more or