treatment for fractures in the region of the elbow, the splints and
bandages causing compression of the blood vessels. There is considerable
effusion of blood, the skin is tense, and the muscles, vessels, and
nerves are compressed; this is further increased if the elbow is flexed
and splints and tight bandages are applied. The muscles acquire a
board-like hardness and no longer contract under the will, and passive
motion is painful and restricted. Slight contracture of the fingers is
usually the first sign of the malady; in time the muscles undergo
further contraction, and this brings about a claw-like deformity of the
hand. The affected muscles usually show the reaction of degeneration. In
severe cases the median and ulnar nerves are also the seat of
cicatricial changes (ischaemic neuritis).

By means of splints, the interphalangeal, metacarpo-phalangeal, and
wrist joints should be gradually extended until the deformity is
over-corrected (R. Jones). Murphy advises resection of the radius and
ulna sufficient to admit of dorsiflexion of the joints and lengthening
of the flexor tendons.

Various forms of _pyogenic_ infection are met with in muscle, most
frequently in relation to pyaemia and to typhoid fever. These may result
in overgrowth of the connective-tissue framework of the muscle and
degeneration of its fibres, or in suppuration and the formation of one
or more abscesses in the muscle substance. Repair may be associated with
contracture.

A _gonorrhoeal_ form of myositis is sometimes met with; it is painful,
but rarely goes on to suppuration.

In the early secondary period of _syphilis_, the muscles may be the seat
of dull, aching, nocturnal pains, especially in the neck and back.
_Syphilitic contracture_ is a condition which has been observed chiefly
in the later secondary period; the biceps of the arm and the hamstrings
in the thigh are the muscles more commonly affected. The striking
feature is a gradually increasing difficulty of extending the limb at
the elbow or knee, and progressive flexion of the joint. The affected
muscle is larger and firmer than normal, and its electric excitability
is diminished. In tertiary syphilis, individual muscles may become the
seat of interstitial myositis or of gummata, and these affections
readily yield to anti-syphilitic remedies.

_Tuberculous disease_ in muscle, while usually due to extension from
adjacent tissues, is sometimes the result of a primary infection throu