A CASE OF TORTICOLLIS 
AND ITS 
LATEST TREATMENT. 
BY S. GROVER BURNETT, A. M., M. D., 
KANSAS CITY, MO. 
Professor of Nervous and Mental Diseases in the Columbian Medical College ; formerly 
Assistant Superintendent of Long Island Home, N. Y., for Mental 
and Nervous Diseases and Inebriates. A Case of Torticollis and Its Latest Treatment.* 
Mr. President and Fellows of the 
Academy:—I do not present this case 
because of its infrequency, but more to 
illustrate the possibilities of persistent 
and proper treatment applied method- 
ically. Every practitioner of any con- 
siderable experience well knows how 
futile have been his attempts to alle- 
viate the severe symptoms, much less 
to approximate a cure in these cases 
of torticollis or so-called wry neck. 
The medicinal portion of the treat- 
ment in such cases is not original 
with me, but it is an inheritance from 
my old friend, Prof. Graeme M. Ham- 
mond, of New York. 
History of Case:—Mr. D. is forty - 
four years of age and was seen by me, 
in consultation with Dr. C. Tester 
Hall, September 20th, 1898. Some 
two years ago he first noticed a ten- 
dency to look to one side. This was 
succeeded by a turning of the head 
laterally. He could easily draw the 
head to the normal position without 
artificial help and would have no re- 
currence of the mal position perhaps 
for a week. However the intervals 
grew shorter and the spasmodic rota- 
tion of the head became insidiously 
progressive. Eight mouths prior to 
his coming to me it became necessary 
for him to use his hand to turn his 
head to the normal position. For a 
while only he could retain it so, vol- 
untarily, when it would again rotate 
to the left through the spasmodic 
action of the upper portion of the tra- 
pezius muscles unless considerable 
force was used to counteract the mus- 
cle spasm. Pain, previously absent, 
became markedly manifest, extending 
from the post-cervical median line to 
the lateral cervical area. While the 
head could be again positioned nor- 
mally, it could only be done so by 
force, and could only be retained there 
but a short time when the head would 
incline to the left without elevation of 
the chin, showing the spasm to be 
mainly in the upper portion of the 
trapezius and not implicating the 
sterno-cleido-tnastoid as is usually the 
case. Pain became continuous but 
with exacerbations. The head as- 
sumed extreme inclination to the left 
and incapacitated the patient for any 
employment. His habits are good 
and excluding some drinking, long 
since discontinued, there has been 
nothing vicious or improper in his 
living. His business is that of nur- 
sery salesman and consequently has 
lived much in the open air. 
Examination:—He is a robust, 
strong, well-developed man. All 
pupillary reactions normal. All eye 
globe rotations normal excepting 
when right external rectus is put on 
a tension a slight nystagmus is devel- 
oped. Right knee jerk is exagger- 
ated; left is normal. No sensory 
symptoms present. Atrophy of left 
side of face is marked. He says slight 
twitching in the left side of his face 
bothered him for a short period but is 
not present now. The masseter mus- 
cle is normal in volume and function. 
All the left cervical musculature, ex*- 
cluding the trapezius, is atrophied, 
soft, flabby. With difficulty, only, 
can the sterno-cleido-mastoid be out- 
lined. The supra and infra spinati, 
shoulder, arm and fore-arin muscles 
are symmetrically atrophied on the 
left side. The grasp in the left hand 
is about a third to one-half less than 
that of the right. All atrophied mus- 
cles respond to the galvanic current 
with the normal cathode plus. 
Remarks:—Since the excessive 
spasm inclining the head to the left 
the patient has continuously, during 
waking hours, tried to resist the spasm 
by means of a stick braced in and 
against the teeth and held in the left 
hand. To the arm so positioned ab- 
normally and practically in non use 
for all other functionation the princi- 
pal amount of atrophy was attributed, 
the verification of which will be men- 
tioned when speaking of treatment. 
*A case presented to the Academy of Medicine of Kansas City, Mo., March 4, 18W. Also the atrophy -of the neck mus- 
cle was thought due to non use. 
As to the facial atrophy, in my 
opinion, it could not be due to non 
use and is probably to be accounted 
for through disturbance in the trophic 
center, there being no facial paralysis 
or asymmetry. 
Pathology:—The underlying mor- 
bidity of this type of wry neck is sup- 
posed to be due to a neurosis involv- 
ing the bulbar and cerebral centers. 
The muscular action becomes unnatu- 
ral and uncontrollable because of the 
unstable stimuli from the defective 
nerve nuclei and cortical cells. The 
whole neuro apparatus is unable to 
functionate normally and the trouble 
is never in the nerve trunk alone. 
The cortical cells controlling the mus- 
cular movements are defective, have 
probably never been normally devel- 
oped and in their now premature de- 
cay their discharge of nerve force is 
sent out in an irregular, intermittent, 
discordant and uncontrollable man- 
ner. 
Treatment:—Outside of common- 
sense treatment to put the patient in 
the best possible condition I put this 
patient on nothing medicinally but the 
fluid extract (Sqibb’s)of conium three 
times daily, beginning with ten min- 
ims and gradually increased until 
he was taking ninety minims three 
times daily when slight vertigo, mus- 
cular weakness and a sense of intoxi- 
cation appeared. The dose was re- 
duced gradually just enough to obvi- 
ate these symptoms. He is now still 
taking seventy-five minims three 
times daily, is comfortable, is in good 
health and as you see can rotate his 
head voluntarily from side to side, 
and does not need to hold his head 
to keep it straight. There is not 
nearly so much atrophy of the neck 
muscles and no perceptible atrophy 
or lack of strength in the arm and 
shoulder muscles. The atrophy of 
the face remains, as near as I can 
judge, unchanged. There was no 
change in the muscle spasm till forty 
minim doses were reached. For the 
pain I gave ten milli-amperes of the 
constant current daily for a time then 
three times-weekly, with the anode 
over the seat of spasm and the cathode 
at an indifferent point. I also gave 
the static indirect (patient charge pos- 
itively) spark briskly over the side 
and back of the neck, shoulder and 
arm. After a week of daily treatment 
with the galvanic current all pain dis- 
appeared and the patient slept well 
and under the influence of the static 
spark the muscular atrophy and loss 
of strength could readily be seen to 
disappear. 
What this patient’s future may be 
is not easily determined but certainly 
if he never improves beyond the pres- 
ent and remains as he is now this line 
of treatment is a success and he has 
been reclaimed from total disability 
and restored to a life of usefulness. 
In the discussion of the case Dr. C. 
Tester Hall said: 
Dr. C. Lester Hall:—The patient, Mr. 
Dansby, an old friend of mine, came to the 
city to consult me with reference to wry 
neck, which was both tonic and clonic. He 
was only enabled to hold his face squarely 
in front of him by the use of a stick which 
acted as a prop and support on his upper 
teeth. Mr. Dansby had received competent 
medical treatment without benefit. I in- 
vited my office associates to see him and we 
all agreed that the case was quite remark- 
able. The question arose whether we would 
continue medicinal treatment or resort to 
surgical measures. 
I invited Dr. Burnett to see him with me 
and after a consultation with him, I advised 
the patient to put himself under Dr. Bur- 
nett’s treatment. The result was not only 
exceedingly gratifying but surprisingly suc- 
cessful, and I wish to congratulate Dr. 
Burnett upon the splendid result obtained 
in what appeared to me to be, at the outset, 
a very discouraging case. 
Dr. C. W. Dulin:—Through kindness of 
Dr. Hall I was, with Dr. Burnett called to 
examine this patient, and will say I was 
very forcibly impressed with the diagnosis 
made by Dr. Burnett after exclusion of 
all other probable lesions. The extreme 
atrophy and inability to use muscles of cer- 
vical, supraclavicular and deltoid regions, 
and the history of long duration suggested 
a very unfavorable prognosis. After having 
visited many physicians and under their di- 
rection followed out many plans of treat- 
ment with no result, I feel highly gratified 
from this excellent result, under irregular 
attendance in so short a time. 
The case illustrates very emphatically 
that in the treatment of various afflictions 
to which mankind is heir, our first duty is 
to make a positive diagnosis and then 
use therapeutic remedies that may be indi- 
cated.