Reprinted from the Journal of Nervous and Mental Disease, September, 1893. 
A New Method of Reducing 
Dislocation of the Cervical Vertebrae. 
BY 
' / 
G. L. WALTON, M.D., 
Instructor in Diseases of the Nervous System, Harvard University ; Physician to 
Neurological Department, Massachusetts General Hospital. Reprinted from the Journal of Nervous and Mental Disease, September, 1893. 
A NEW METHOD OF REDUCING DISLOCATION 
OF CERVICAL VERTEBRAE.1 
By G. L WAI/TON, M.D., 
Instructor in Diseases of the Nervous System, Harvard University ; Physician to 
Neurological Department, Massachusetts General Hospital. 
PERSONAL experience has led me to believe that 
dislocation of cervical vertebras, without fatal re- 
sults, is by no means of rare occurrence. Besides 
the eight cases which I published in 18892 and 1890,3 I 
had seen seven more, and had been communicated with 
regarding an eighth, making a total of sixteen, up to the 
publication of an article on the subject in 1892.4 In that 
publication a method of reduction was suggested which 
was theoretically correct, as shown by the manipulation 
of the vertebrae and by experiments upon the cadaver,, 
made by Dr. Richardson and myself. 
A case has recently occurred in the Massachusetts 
General Hospital, in which the practical success of the 
method was demonstrated upon a patient by Dr. Beach- 
This case will be reported by him later, so that I refrain 
from going into the details, but its success justifies me 
in recalling the subject here. 
The commonest form of dislocation, without fatal re- 
sults, is the unilateral form, in which an articular process 
slips over the one below, causing the head to cant to one 
side and to twist so as to produce a similar position to 
that assumed in torticollis, the diagnostic feature being 
the immobility of the head in its new position, combined 
1 Read before the American Neurological Association, July, 1893. 
2 Dislocation of Cervical Vertebrae ; Five Cases ; Recovery without 
Operation.—-Journal of Nervous and Mental Disease, 1889 ; also Bos- 
ton Medical and Surgical Journal, March 21, 1889. 
3 Dislocation of Cervical Vertebrae without Fatal Results.—Boston 
Medical and Surgical Journal, May 8, 1890. 
4 Dislocation of Cervical Vertebrae.—International Clinics, 1892, Sec- 
ond Series, II., p. 207. 2 
G. L. WALTON. 
with laxity of the muscles, the contraction of which 
would have produced the deformity, while those on the 
opposite side are put upon the stretch. 
The method, the success of which has been es- 
tablished as far as one case can do so, is as follows : 
Suppose the left articular process of one vertebrae has 
slipped forward over the corresponding articular process 
of the vertebrae below and fallen into the depression 
anterior to that process. This turns the face to the right 
and bends the head over toward the left, as in spasm of 
the left sterno-cleido-mastoid. No amount of extension 
will remove the vertebrae from its new position in the 
the slightest degree, as has been often shown; nor will 
rotation be available until the depressed articular process 
is raised. The proper method is simply, therefore, to 
first raise this process, then rotate. This can be accom- 
plished only by extending the head obliquely backward 
toward the right, using the transverse process on the 
right as a fulcrum. The ligaments,6 which have held 
the vertebrae firmly in its faulty position, make no oppo- 
sition to this movement, so that no force is required to 
first elevate in this way, and then to rotate to the proper 
position. 
In bilateral dislocation it is quite probable that this 
maneuvre, carried out first on one side, then on the 
other, will meet with success. Indeed, this is probably 
the movement made involuntarily by the patient him- 
self in a case of bilateral dislocation forward, occurring 
at the Massachusetts General Hospital several years ago, 
in the service of Dr. Warren. In this case attempts at 
reduction by extension were unsuccessful, but spon- 
taneous recovery occurred through muscular movement, 
produced while cold water was being poured upon the 
patient’s back, the patient meantime sitting in a warm 
bath. In this case the existing paralysis of all extremi- 
ties disappeared with great rapidity, and perfect recov- 
6 The muscles of the neck may be disregarded, the ligaments alone 
holding the vertebrae firmly, as shown by the experiments upon the 
cadaver, in which all muscles were removed. DISLOCATION OF CERVICAL VERTERRAS. 
3 
ery followed. This case shows that direction—not 
force—is the key to reduction, as does also the case occur- 
ring in the practice of Dr. D. W. Hodgkins, of East 
Brookfield, who wrote me that reduction, already at- 
tempted without success, occurred accidentally, while the 
patient was being carried to the house, through the in- 
harmonious movement of Dr. Hodgkins, who carried the 
head, and those who carried the trunk and limbs. 
Again, in a former case, upon which Dr. Beach 'was 
about to attempt reduction, involuntary movements of 
the patient under ether brought about the desired result 
without outside interference. 
These facts led me to the study, of which this method 
is the outcome, a method which seems certainly worthy 
of reiteration, as the practitioner is liable to meet these 
cases at any time, they being certainly much more com- 
mon than has been hitherto supposed, the diagnosis 
probably being not infrequently overlooked, either 
through lack of acquaintance on the part of the prac- 
titioner with the characteristic features, or through hesi- 
tation in making a diagnosis of so serious import in 
cases where no paralysis exists, such paralysis often 
failing to appear through the ample lumen left for the 
passage of the cord in the unilateral form of dislocation. PRESS OF RAFF & CO. 
134 & 136 West 26th Street, 
NEW YORK. THE ALLIANCE PRESS, 
Successors to Raff & Co., 
134 & 136 West 26th Street, 
NEW YORK.