head is inclined slightly
forward, the shoulder is depressed, the arm hangs heavily by the side
and is slightly rotated forward, the scapula is drawn away from the
spine and rotated on its horizontal axis, and there is slight cervical
scoliosis with the concavity towards the affected side. The trapezius
is markedly wasted, and is, therefore, less prominent in the neck than
normally, and the functions of the arm and shoulder are impaired,
especially in making overhead movements. In time other muscles
compensate in part for the loss of the trapezius.

When divided accidentally, the nerve should be immediately sutured.
Even when the paralysis has lasted for some time, secondary suture
should be attempted; if this is impossible, the peripheral end should
be anastomosed with the anterior primary divisions of the third and
fourth cervical nerves (Tubby). Massage, electricity, and the
administration of tonics are also indicated.

XII. _Hypoglossal Nerve._--This nerve has been ruptured in fractures
passing through the canalis hypoglossi (anterior condylar foramen). It
is also liable to be divided in wounds of the submaxillary region--for
example, in cut throat, or during the operation for ligation of the
lingual artery, or the removal of diseased lymph glands.

The paralysed half of the tongue undergoes atrophy. When the tongue is
protruded, it deviates towards the paralysed side, being pushed over
by the active muscles of the opposite side. Speech and mastication are
interfered with, the tongue feeling too large for the mouth; in time
this disability is to a large extent overcome.

#The Cervical Sympathetic.#--The cervical sympathetic cord and its
ganglia may be injured in the neck by stabs or gun-shot wounds, or in
the course of deep dissections in the neck; and in injuries of the
lower part of the cervical enlargement of the spinal cord (p. 417) or
of the first dorsal nerve root.

Paralysis of the cervical sympathetic is characterised by diminution
in the size of the pupil on the affected side. The pupil does not
dilate when shaded, nor when the skin of the neck is pinched--"loss of
the cilio-spinal reflex." The palpebral fissure is smaller than its
fellow, and the eyeball sinks into the orbit. There is anidrosis or
loss of sweating on the side of the face, neck, and upper part of the
thorax, and on the whole upper extremity of the affected side.

CHAPTER XV

DISEASES OF THE CRANIAL BONES

Suppurative peri