EPIDEMIC MYALGIA AFFECTING THE- TRAPEZIUS MUSCLE BY

in which he described a morbid condition of the intercostal and abdominal muscles, outbreaks of which occur in sufficiently large numbers in certain localities to reach epidemic proportions. The term " epidemic myalgia " was used, on the suggestion of.the late Sir George Buchanan, in order to avoid a slur upon the pleasant island of Bornholm. In his comprehensive monograph Sylvest collected all the known descriptions of this disease that had ap-peared before his own publication, and since that date outbreaks have been recognized more readily and epidemics have been described in most parts of the world. Furthermore, several outbreaks have been observed and recorded in which the trapezius muscle has been principally involved, and which have had an appreciable morbidity rate. Clinical Description The morbid condition to be described differs from Bornholm disease in several important features. Only one muscle seems to be affected, there is usually absence of pyrexia, and the only complication which has been commonly described is persistent fibrositis. This syndrome may have a sudden or insidious onset, and pain is the mostprominent feature, which may be maximal from the start, or which may increase rapidly in severity, reaching its maximum within a few hours of onset. It is persistent and is increased by any movement in which the affected muscle is required to contract. The pain may be lancinating or aching, radiating to occiput or down the arm; paraesthesia of the arm on the affected side has been recorded. Headache is usually occipital, and is common in both the pro-dromal and the fully developed stages. Pyrexia is unusual and, if present, never exceeds 100 ° F. Catarrhal conditions of the upper respiratory tract have had a high incidence in some outbreaks. The condition may quickly resolve, but it more usually extends over a period of from eight to fourteen days, gradually diminishing in severity. During the course of the disease complications are excep-tional, but chronic fibrositis may occur as a sequel