MEDICAL MATTERS.                            Stewart, 1908, says : “ In the operative
                                                    treatment two points of importance call for
                                                    consideration ; first, to rectify the distortion by
     THE TREATMENT O F TORTICOLLIS.                 cutting or by manipulation ; second, to main-
    Mr. Paul B. Roth, F.R.C.S., has a very tain the head in a suitable position by some
practical article in the Lnizcet on the treatment form of apparatus. The very best form of
of Torticollis met with in childrep, which is the latter is the plaster helmet. . . . After
usually described as congenital, and which is the wound has healed, the helmet may be left
due to a non-spasmodic shortening of the on for from four to eight weeks, or even
sterno-mastoid muscle. The aim of the.Paper longer.
is to call attention to the fact that after torti-     If, after the splint has heen removed, it be
collis has been treated by tenotomy no reten- found that the deformity be overconie, it will
tive apparatus is necessary. The four cases be necessary, in order to prevent its return,
described were in-patients at the London to institute systematic eserciscs, to employ
Hospital.                                           massage, and constantly to take advantage of
    It is generally taught in orthopaedic works posture.”
that the treatment for this condition is division
of the muscle, followed by use of retentive            Finally, G. A. Wright, 1910,gives an account
apparatus, and Mr. Roth quotes the following        of the use of elastic traction after tenotomy for
authorities :-Thus Tubby says : ‘ The prin- torticollis, and obviously regards its use as
ciples which should guide us in undertaking necessary.
operative measures are : . . . 2. After teno-          The above quotations mould show that after
tomy, to maintain the improved position by operation the use of retentive apparatus is
means of a simple apparatus, and such as does imperative.            Mr. Roth points out that it is
not interfere with daily manipulations. The superfluous.
head is fixed in plaster in the over-corrected         It will be noticed, he writes, that both
position for 10 to 14 days, and the patient is Whitman and Stewart advocate systematic
then sent out with a plaster-of-Paris collar. exercises {rfter retentive apparatus has been
 It is well t o divide this anteriorly, and to lace worn for many months; and that Tubby
it, so that it may be taken off and daily move- recommends them coitctiwently with it. It is
ments of active and passive manipulation prac- submitted that they should be used from the
 tised. The collar should be worn for four t o first, and without apparatus of any sort whatso-
six months.’                                        ever. It will be seen further that these writers
    Bradford and Lovett, 1900, say : “ The head do not state what esercises should be done ;
should be immediately rectified and retained there is only a general statement about them.
in a corrected position, either by means of a Unfortunately, in the majority of orthopaedic
plaster-of-Paris bandage enclosing the head works, whenever esercises are mentioned, the
and trunlr. or . . . . the bed frame described same absence of detail is noticeable.
in the treatment of caries of the mine. . . .          While house-surgeon at the London Hospikd,
This can be employed for a week Gr ten days. in 1909, Mr. Roth operated upon four ‘cases
and a light retention appliance be used, . of torticollis. After division of the muscle and
This latter should be worn for from three to fascix: by the open operation, the head was
six months, when permanent cure should be firmly manipulated into an over-corrected posi-
established. Without the use of the apparatus tion. The child was then put back to bed, with
after operation relapse is lilrely to occur,”       the head between sand-bags, and on the second
    Royaj Whitman, 1907, says: “The head or third day was allowed up and gentle passive
 should be fixed during the process of repair in movements were begun. On the filth or sisth
the over-corrected position. . . In this atti- day active movements took their place, and after
 tude a plaster bandage should be applied, removal of the stitches the mother was shown
 surrounding the head and the thorax. It should how to superintend the carrying out of these
 remain .    .     , until the tendency towards movements at home for five minutes tiyice a
 deformity has been checked. Fixation in day. These four patients are completely cured.
 the over-corrected position is very important in By “ cured ” is meant that a year after operation
 childhood, as an aid in overcoming.thedeformity the child holds his head perfectly straight, that
 habit. .. . . The plaster bandage is usually he can twist his head round to look over one
 retained from four to eight weeks. When it is shoulder just as well as over the other; and
 removed, massage, manipulation, and gym- that, only by finding the operation scar, can the
 nastic training are indicated.”                     affected side be discovered.
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