umatic torticollis," the pain is located
in one side of the neck, and is excited by some inadvertent movement.
The head is held stiffly on one side as in wry-neck, the patient
contracting the sterno-mastoid. There may be tenderness over the
vertebral spines or in the lines of the cervical nerves, and the
sterno-mastoid may undergo atrophy. This affection is more often met
with in children.

In _pleurodynia_--_intercostal fibrositis_--the pain is in the line of
the intercostal nerves, and is excited by movement of the chest, as in
coughing, or by any bodily exertion. There is often marked tenderness.

A similar affection is met with in the _shoulder and arm_--_brachial
fibrositis_--especially on waking from sleep. There is acute pain on
attempting to abduct the arm, and there may be localised tenderness in
the region of the axillary nerve.

_Treatment._--The general treatment is concerned with the diet,
attention to the stomach, bowels, and kidneys and with the correction
of any gouty tendencies that may be present. Remedies such as
salicylates are given for the relief of pain, and for this purpose drugs
of the aspirin type are to be preferred, and these may be followed by
large doses of iodide of potassium. Great benefit is derived from
massage, and from the induction of hyperaemia by means of heat. Cupping
or needling, or, in exceptional cases, hypodermic injections of
antipyrin or morphin, may be called for. To prevent relapses of lumbago,
the patient must take systematic exercises of all kinds, especially such
as bring out the movements of the vertebral column and hip-joints.

[Illustration: FIG. 109.--Volkmann's Ischaemic Contracture. When the
wrist is flexed to a right angle it is possible to extend the fingers.

(Photographs lent by Mr. Lawford Knaggs)]

#Contracture of Muscles.#--Permanent shortening of muscles results from
the prolonged approximation of their points of attachment, or from
structural changes in their substance produced by injury or by disease.
It is a frequent accompaniment and sometimes a cause of deformities, in
the treatment of which lengthening of the shortened muscles or their
tendons may be an essential step.

#Myositis.#--_Ischaemic Myositis._--Volkmann was the first to describe a
form of myositis followed by contracture, resulting from interference
with the arterial blood supply. It is most frequently observed in the
flexor muscles of the forearm in children and young persons under