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Two clinical types are recognised, one in which the disease progresses slowly and remains confined to the cervical glands for two or more years; the other, in which the disease is more rapidly disseminated and causes death in from twelve to eighteen months.
The spinal column, or backbone, is a marvelous piece of mechanism, combining offices which nothing short of perfection in adaptation and arrangement could enable it to perform. It is the central structure to which all the other parts of the skeleton are adapted. It consists of numerous separate bones, called vertebræ. The seven upper ones belong to the neck, and are called cervical vertebræ.
The cold abscess which results from tuberculous glands is to be distinguished from that due to disease in the cervical spine, retro-pharyngeal abscess, as well as from congenital and other cystic swellings in the neck. Prognosis.
At the last operation I removed the teeth that were loose with certain parts of the jawbone." In the next chapter there is an account of the treatment of a remarkable case of abscess of the uvula. In the following chapter the swelling of cervical glands is taken up. In his experience expectant treatment of these was best.
Numerical anomalies of the vertebrae are quite common, generally in the lumbar and dorsal regions, being quite rare in the cervical, although there have been instances of six or eight cervical vertebrae. In the lower animals the vertebrae are prolonged into a tail, which, however, is sometimes absent, particularly when hereditary influence exists.
The retro-pharyngeal glands lie on each side of the median line upon the rectus capitis anticus major muscle and in front of the pre-vertebral layer of the cervical fascia. When they are infected with pyogenic organisms or with tubercle bacilli, they may lead to the formation of one form of retro-pharyngeal abscess.
However, the chances of a fatal issue in injuries of the vertebrae vary inversely with the distance of the point of injury from the brain. Keen has recorded a case in which a conoidal ball lodged in the body of the third cervical vertebra, from which it was extracted six weeks later. The paralysis, which, up to the time of extraction, had affected all four limbs, rapidly diminished.
It most often appears in the early years of life, sometimes in relation to a pigmented or hairy mole. It is of slow growth, may remain stationary for long periods, and has little or no tendency to become malignant. It is usually subcutaneous, and is frequently situated on the head or neck in the distribution of the trigeminal or superficial cervical nerves.
There are seven of these vertebrae in man and almost all the other mammals, even if the neck is as long as that of the camel or giraffe, or as short as that of the mole or hedgehog. If each species had been created separately, it would have been better to have given the long-necked mammals more, and the short-necked animals less, cervical vertebrae.
"The bullet entered at the juncture of the nasal and frontal bones," explained Harley, rapidly, "and it came out between the base of the occipital and first cervical. Without going into unpleasant surgical details, the wound was a perfectly straight one. There was no ricochet." "I understand that a regulation rifle was used?" "Yes," said Inspector Aylesbury; "we have it."
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