The Diagnosis of Surgical Diseases

that disease which Leyden has proposed to call Rust-s disease, a peculiar position of the head is noticed.This disease is merely a special kind of Pott-s, a caries of the uppermost cervical vertebrae, more particularly a caries which occurs in the joint between atlas and the odontoid process. It well merits a special name and description, not only because carious erosion of the vertebrae in the neighbourhood of the vital centres of the spinal cord cause the most serious dangers, but also because the symptoms of the disease are highly interesting, and permit of the probable diagnosis with considerable certainty. As turning movements of the head take place in a horizontal plane about the vertical odontoid process of the axis, the head and atlas moving as one, it is evident that as a result of the inflammation of this joint turning movements of the head are entirely inhibited. Nodding movements take place in the joint between atlas and the occipital bone, and these are only partially or not at all impeded. Loss of the power of turning the head, with persistence of nodding movements, are, therefore, a diagnostic guide. The patient himself furnis"hes a further clew by supporting his head with hlts hands on changing from the sitting to the recumbent posture, and vice versa. Some patients even lift the head by the hair when they attempt to rise. In some unknown way they divine, or unconsciously avoid, the danger which a sudden movement might occasion. In the end m...