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February 24, 1945


JAMA. 1945;127(8):436-439. doi:10.1001/jama.1945.02860080008002

Stiffness of the neck is often found in clinical practice accompanying meningeal irritation. Yet, paradoxically enough, patients have been erroneously diagnosed as having had meningitis because of its presence. We had to note the conditions where stiff neck was found, for it soon became obvious that not all stiff necks were due to meningeal irritation.

In order to establish a diagnosis when this condition is present, one has to collect the evidence based on inspection, percussion, palpation and rarely auscultation. The factors causing stiffness of the neck originate in nerves, muscles, bones, fascia, ligaments, glands and other structures. The neck is inspected from front, side and back. One notes how the head is held. Is it braced and splinted to avoid pain? Is there pain in certain positions only? Is pain absent? Is the entire head and neck moved in a marionette manner or is the neck stiffened so that

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