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Cervical muscles in eleven Orders and nineteen species of birds were compared by semidiagramatical illustrations of the lateral view. The main series of cervical muscles studied was given the following nomenclature:1. Dorsal muscles1. Biventer muscle, M. biventer cervicalis2. Dorsal long cervical muscle, M. longus colli posticus (M. spinalis)a. Longitudinal part, pars longus b. Anterior part, pars anteriorc. Posterior part, pars posterior d. Inferior part, pars inferior3. Dorsal profound cervical muscle, M. profundus colli posticus4. Intercrestal muscle, M. intercristalisII. Lateral muscles1. Oblique cervical muscle, M. obliquus colli2. Lateral cervical muscle, M. colli lateralis (M. intertransversalis)III. Ventral muscles1. Ventral long cervical muscle, M. longus colli anticusa. Longitudinal part, pars longus b. Anterior part, pars anteriorc. Posterior part, pars posteriorThe development of these muscles is extremely variable both adaptively and possibly taxonomically and in some groups is very specialized. These complexities of the avian cervical muscle system are the natural result of their variety of uses of the neck in food-getting and other activities. The myology of this interesting and important part of avian body, however, has been curiously neglected and is open to future detailed comparative studies.

A current direction in research into cervical disorders is towards investigating the value of a “mechanisms” approach to diagnosis. This commentary reviews some of the research investigating the pathophysiological features of neck pain, in terms of changes in the articular, muscle, sensorimotor and sensory systems. Changes have been found in patterns of cervical muscle activation in cognitive, functional and automatic tasks in neck pain patients. In addition, some patients have been found to have disturbances in features of the postural control system in association with their neck disorders. Altered responses to sensory testing have also been determined, particularly in some patients with whiplash-induced neck pain. The value of this mechanisms approach to diagnosis is in its ability to direct specific treatment strategies to address the precise impairments presenting in the individual neck pain patient. It supports the evidence that indicates that a multimodal approach to management is likely to be most efficacious.

Aluminum-containing drugs are used extensively to bind dietary phosphate and as antacids, but little is known about toxicity and tissue uptake of ingested aluminum. Aluminum concentrations were measured by neutron activation analysis in tissues taken from hyperparathyroid and normal human subjects and from rats. The parathyroid glands contained significantly more aluminum per unit mass than did thyroid or cervical muscle. The concentration of aluminum in the parathyroids appears to be linearly related to dietary aluminum intake.

Congenital muscular torticollis (CMT) is a disorder characterized by a shortening of at least one of the cervical muscles and tilting of the head to the opposite side. The most commonly affected muscle is the sternocleidomastoid (SCM) muscle. An unusual case is presented here: a CMT patient with involvement of the trapezius muscle in addition to the SCM muscle who has recently been treated at North Carolina Memorial Hospital. This patient still has a slight residual deformity despite two surgical procedures, physical therapy, and splinting. A review of 41 CMT patients who presented to this institution from 1952 to the present demonstrates that the disorder is extremely variable in terms of severity of deformity and response to various types of therapy. The condition will resolve spontaneously in the majority of patients by the age of 1 year, and if the condition has not resolved by then, it is unlikely to do so without surgery. We therefore believe that surgery should be postponed until after 1 year of age. Most of the patients requiring surgery are effectively treated by division of the involved muscle in at least one area with or without lengthening of the SCM muscle. Splinting and physical therapy are recommended postoperatively. A few patients such as the unusual one with involvement of the trapezius muscle resist our most aggressive therapeutic efforts.

A captured box turtle, Terrapene carolina, was found to have a large swelling on the neck, the result of a massive, mixed bacterial infection of Citrobacter, Enterobacter, Proteus morganii, Proteus rettgeri, and a non-pigmented strain of Pseudomonas. A well-defined caseous mass between the superficial and deep cervical muscles was surrounded by purulent material. An eroded squamosal bone allowed purulent material to gain access to the pharynx. The skull was markedly asymmetrical, due primarily to left squamosal enlargement. Initial entry of the pathogens via pharyngeal trauma is suggested.

Summary: Of 100 randomly chosen, adult male Wistar rats in the breeding colony at the Centre de Neurochimie, Strasbourg, 31 presented spontaneous, nonconvulsive epileptic seizures: wave-and-spike discharges, 7–11 cy-cles/s, 200–600 μV, accompanied by behavioral arrest and myoclony of the vibrissae and of the facial and cervical muscles. Pentylenetetrazol (PTZ) 10 and 20 mg/kg increased the duration and number of seizures by 100–150% in these spontaneously epileptic animals, and caused identical seizures in apparently normal rats. Sodium valproate, diazepam, trimethadione, and ethosux-imide suppressed the spontaneous seizures and protected against PTZ-induced seizures in a dose-dependent fashion. Carbamazepine and diphenylhydantoin were inefficacious or aggravative in the two cases. The clinical, EEG, and pharmacological observations suggest that the Wistar rats displaying spontaneous seizures constitute a valid physiological and pharmacological model of petit mal absences, presenting advantages compared to the usual models in which seizures are induced byinjected epileptogenic drugs. RESUME Sur 100 rats Wistar, mâles, adultes, preleves au hasard dans Ľe1evage du Centre de Neurochimie de Strasbourg, 31 ont presente spontanement des crises epileptiques nonconvulsives (de-charges de pointes-ondes de 7–11 c/s et de 200–600 μ V accom-pagnees ďun arret de Ľactivite et de myoclonies des vibrisses et de la musculature faciale et cervicale). Le pentylenetetrazol a 10 et 20 mg/kg augmente de 100–150% la duree et le nombre des crises chez les animaux spontanement epileptiques; aux memes doses, le pentylenetetrazol fait apparaitre des crises iden-tiques chez les animaux apparemment indemnes. Le valproate de sodium, le diazepam, la trimethadione, et Ľethosuximide sup-priment les crises spontanees et protegent contre les crises induces par 20 mg/kg de PTZ de facon dose-dependante. La car-bamazepine et la diphenylhydantoine sont inefficaces ou aggravates sur les deux types de crises. Ľensemble des resultats cliniques, electroencephalographiques, et pharmacologiques permettent de penser que les crises spontanees du rat Wistar constituent un bon modele physiologique et pharmacologique ďabsences. Ce modele semble presenter quelques avantages par rapport aux modeles usuels induits par des injections de drogues epileptogenes. RESUMEN De las 100 ratas Wistar machos y adultos, seleccionadas al azar de la colonia de crias del Centro de Neuroqui'mica en Es-trasburgo, 31 presentaron ataques epilepticos no convulsivos: descargas punta-onda de 7 a 11 ciclos por segundo y 200 a 600 μ.V, acompanadas de interrupcion del comportamiento y mio-clonias de las vibrisas y de los musculos faciales y cervicales. La administracion de 10 a 20 mg/kg de pentilentetrazol (PTZ) incrementaron en un 100 a 150% la duracion y el numero de los ataques en estos animales espontaneamente epilepticos y causo ataques identicos en ratas aparentemente normales. El valproato sodico, el diazepan, la trimetadiona y la etosuximida suprimieron los ataques espontaneos y protegieron a las ratas de las crisis inducidas por el PTZ. La carbamazepina y la difenilhidantoina fueron ineficaces o perjudiciales en dos casos. Las observa-ciones clinicas, electroencefalograficas y farmacologicas sugi-eren que las ratas Wistar que muestran ataques espontaneos con-stituyen un valido modelo fisiologico y farmacologico de las au-sencias petit-mal. Este modelo presenta ventajas con respecto a modelos comunes en los que los ataques se inducen inyectando drogas epileptogenicas. ZUSAMMENFASSUNG Von 100 zufallig ausgewahlten mannlichen erwachsenen Wistar-Ratten aus der Zuchtkolonie am Centre de Neurochimie, Strasburg zeigten 31 spontane, nicht konvulsive epileptische Anfalle: wave and spike Entladungen von 7 bis 11 c/s und 200 bis 600 uV, die von einem Verharren und Myokloni der Schnau-zhaare sowie der facialen und cervikalen Muskeln begleitet waren. Pentylentetrazol (PTZ) in einer Dosis von 10 und 20 mg/ kg verlangerte bei diesen spontan epileptischen Tieren die Dauer und erhohte die Anzahl der Anfalle um 100 bis 150%. Daruber hinaus verursachte diese Dosis identische Anfalle bei scheinbar normalen Ratten. Natrium Valproat, Diazepam, Trimethadion und Ethosuximid unterdruckten die spontanen Anfalle und schutzten, in Abhangigkeit von der Dosis, vor PTZ-induzierten Anfallen. Carbamazepin und Diphenylhydantoin waren wir-kungslos; in 2 Fallen verstarkten sie die Anfalle. Die klinischen, EEG, und pharmakologischen Beobachtungen legen nahe, daβ die Wistar-Ratten mit spontanen Anfallen ein gutes physiolo-gisches und pharmakologisches Modell der Petit Mai Absencen darstellen, das Vorteile gegenuber den ubrigen Modellen bietet, bei denen epileptogene Medikamente injiziert werden mussen.

The challenge we carried out, which regularly brought about the death of the control animals, led us to study the different factors influencing the pathogenicity of the rabies virus. So, the method of preparation is important. The strain NYC, prepared from the salivary glands is extremely pathogenic for dogs; however, when it is prepared from mouse brains after nine passages have been made, it proves to be already partially modified. One then notices a death-rate which is less severe, even when larger quantities of virus are employed, and also the presence of some aberrant phenomena. (The survival of some of the infected animals and the nature of their inapparent forms of infection were confirmed by serology.) The significance of the route of inoculation in the different species of animals was studied. The injection in the crotaphytes was reserved for dogs, the cervical muscles for cats and the masseters for sheep. Paradoxically, cats prove to be most resistant to the challenge under our conditions. Finally the numerical data, allowing us to compare the different strains, modified, fixed or wild, was established. The data was based on the incubation period and on the differences between the titres obtained via intramuscular routes and intracerebral routes in the mice.

Ten patients with spasmodic torticollis were treated by injection of a total dose of 30 ng of botulinum toxin type A into the affected sternomastoid and posterior cervical muscles. Nine patients reported improvement in head position and control, which was confirmed in seven cases by clinical assessment and "blind" videotape ratings before and 6 weeks after injection. Five patients who had pain reported relief. Seven patients had mild transient dysphagia after injection; two who were given a more concentrated solution of the toxin developed more severe dysphagia, but this also recovered. Other minor transient side effects included weakness of the voice and local pain. The beneficial effects of botulinum toxin injections lasted some 2 to 3 months. A slight reduction in the total dose of toxin injected avoided the main side effects, and this method of treatment appears to offer successful control of head position and pain in the majority of patients with torticollis.

Positive identification of posterior cervical paraspinal muscles were made on computed tomography (CT) scans and correlated with the findings on cadaveric cross-sections of corresponding levels. Two frozen, fixed cervical cadaveric sections were CT scanned at various levels, then sliced cross-sectionally at the appropriate thickness. Individual muscles of the posterior cervical area were then identified on the cadaveric section and the corresponding CT scan section. In both specimens, identification of the individual muscles was possible on CT scan. Detection of normal anatomical variations of the cervical muscles was also possible on CT scans, but muscle fiber orientation was not. It is concluded that positive identification of posterior cervical paraspinal musculature on CT scan is possible. This provides the physical therapist with a greater understanding of both cervical cross-section anatomy and gross anatomy of the posterior cervical paraspinal musculature. Information obtained through CT scanning can assist the physical therapist in treatment of patients with injuries to the soft tissue structures of the cervical spine. J Orthop Sports Phys Ther 1986;8(1):15-26.

ummary Chloramphenicol plasma levels were measured in adult cattle, sheep and horses after oral and intramuscular administration of a single dose of 10 mg. chloramphenicol/kg. body weight. The chloramphenicol powder and its palmitate were given orally. With an interval of 1 week chloramphenicol was also injected intramuscularly at two injection sites in the cervical muscle as a 20 % solution. After oral administration of chloramphenicol levels were found in the plasma in horses only. The mean maximum value of 0.6 microgram/ml. was reached half an hour later. In vitro studies with rumen contents of sheep indicated that chloramphenicol was degraded rapidly by the rumen microorganisms. Intramuscular injection however, provoked in all animals examined measurable blood levels of chloramphenicol, which with regard to the maximal level and the course of time, differed from species to species. After intramuscular injection an average maximal value of 1.7 microgram/ml. was attained at three to six hours in cattle. The corresponding level in sheep was 4.1 microgram/ml. at one hour and 0.9 microgram/ml. during the first three hours in horses. It is widely accepted that the minimal therapeutic blood level of chloramphenicol should be 5 microgram/ml. This blood concentration was never attained with a 10 mg./kg. dose rate. This level of antibiotic, however, needs serious investigation. Zusammenfassung Plasma-Chloramphenicol-Spiegel nach oraler und intramuskularer Anwendung bei Pferden, Rindern und Schafen Bei Pferden, Rindern und Schafen wurden die Plasma-Chloramphenicol-Spiegel nach einmaliger oraler und intramuskularer Verabreichung von 10 mg Chloramphenicol/kg Korpergewicht bestimmt. Das Chloramphenicol wurde oral als Base und als Palmitat verabreicht. Von einer 20 %igen Losung (Leukomycine® Bayer) wurden acht Tage spater 10 mg/kg an zwei Stellen tief in den Nackenmuskeln injiziert. Nach oraler Behandlung konnte nur im Plasma von Pferden Chloramphenicol nachgewiesen werden. Der maximale Gehalt wurde nach einer halben Stunde erreicht und betrug durchschnittlich 0,6 μg/ml. Bei „in vitro” Experimenten mit Panseninhalt von Schafen wurde das Chloramphenicol durch die mikrobielle Flora sehr schnell abgebaut. Die intramuskulare Injektion bewirkte hingegen bei alien Tierarten mesbare Plasmaspiegel, die allerdings hinsichtlich Tierart, sowie maximaler Konzentration und zeitlichem Verlauf sehr unterschiedlich waren. Bei Rindern wurde nach 3–6 Stunden ein maximaler Mittelwert von 1,7 μg/ml, bei Pferden wahrend der ersten drei Stunden ein solcher von 0,9 μg/ml und bei Schafen nach einer Stunde ein solcher von 4,1 μg/ml erreicht. Allgemein wird angenommen, das der minimale therapeutische Blutspiegel von Chloramphenicol 5 μg/ml betragt. Bei einer Dosis von 10 mg/kg wurde diese Blutkonzentration nie erreicht. Das Dosisproblem erfordert weitere Untersuchungen. Resume Taux de chloramphenicol dans le plasma apres usage oral et intramusculaire chez des chevaux, des bovins et des moutons Le taux du chloramphenicol dans le plasma a ete determine chez des chevaux, des bovins et des moutons apres une application unique orale et intramusculaire de 10 mg de chloramphenicol par kg de poids. Le chloramphenicol a ete administre oralement comme base et comme palmitate. Une solution a 20 % (Leukomycine® Bayer) a ete administre huit jours plus tard a raison de 10 mg/kg dans deux endroits profonds de la musculature. Le chloramphenicol n'a ete mis en evidence que dans le plasma des chevaux apres le traitement oral. La quantite la plus grande fut atteinte apres une demi-heure et etait en moyenne de 0,6 μg/ml. Le chloramphenicol etait tres rapidement degrade par la flore microbienne dans les experiences faites in vitro avec le contenu de la panse de moutons. Le taux mesure dans le plasma lors d'injections intramusculaires etait tres variable quant a sa concentration maximale et a son maintien dans le temps selon l'espece animale. 1,7 μg/ml apres 3–6 heures fut une valeur maximale chez le bovin, 0,9 μg/ml pendant les trois premieres heures chez le cheval et 4,1 μg/ml apres une heure chez le mouton. On admet en general que le taux sanguin therapeutique minimal de chloramphenicol est de 5 μg/ml. Cette concentration sanguine n'est pas atteinte avec une dose de 10 mg/kg. Le probleme des doses reclame de nouvelles recherches. Resumen El nivel plasmatico de cloramfenicol tras administracion oral e intramuscular en caballos, vacunos y ovejas En equinos, bovinos y ovinos se valoro el nivel de cloramfenicol plasmatico tras administracion unica oral e intramuscular de 10 mg. cloramfenicol/kg. peso en pie. El cloramfenicol se facilito por via oral como base y como palmitato. Ocho dias mas tarde se inyectaron en dos sitios profundus de los musculos nucales 10 mg./kg. de una solucion al 20% (Leucomicina® Bayer). Tras el tratamiento oral solo se pudo identificar cloramfenicol en el plasma de caballos. El contenido maximo se alcanzo al cabo de media hora y era del orden de 0.6 μg./ml. En experimentos in vitro con contenido ruminal de ovejas se desintegra el cloramfenicol muy rapidamente por la flora microbiana. Ahora bien, la inyeccion intramuscular ocasionaba en todas las especies animates niveles plasmaticos mensurables, los cuales variaban sin embargo mucho con respecto a la especie animal, la concentracion maxima y el curso temporal. En bovinos se alcanzo tras 3–6 horas un valor medio maximo de 1.7 μg./ml., en caballos durante las tres horas primeras uno de 0.9 μg./ml. y en ovejas al cabo de una hora uno de 4.1 μg./ml. Se admite en general que el nivel terapeutico minimo en sangre de cloramfenicol es del orden de 5 μg./ml. Con una dosis de 10 mg./kg. no se alcanzo nunca esta concentracion en sangre. Tiene que seguir investigandose el problema de la dosificacion.

Summary Six dogs were used for a radiological investigation of movement of the cervical vertebrae for comparison of range of motion, instantaneous centers of motion and patterns of flexion and extension with those determined for man. Five dogs were embalmed and one live dog was investigated under the influence of general anesthesia. All animals were adult with the exception of one of the embalmed animals. None of the animals exhibited any abnormalities of cervical vertebrae or intervertebral discs. It was demonstrated that range of motion of the dog cervical spine exceeds that of man, largely due to a greater flexion-extension range of the atlanto-occipital joint and of lateral flexion of the cranial and caudal cervical spine. Patterns of flexion and extension of the cranial and caudal cervical spine of the dog are similar to that of man with no differences in the location of centers for these movements. Other differences were primarily due to the organization of intervertebral articulations. These relationships are discussed in regard to the significance of individual groups of cervical muscles, joint functions and influence of movement on the spinal cord.

• After tonsillectomy, atlantoaxial subluxation occurred in two patients. Operations had been performed with the use of local anesthesia, and it was assumed that, during the injection of anesthetics, bacteria infected the prevertebral space. The initial symptoms of the prevertebral space infection were neck pain and stiffness; the movements of the neck were minimal, and opening of the mouth caused pain due to spasm of the deep cervical muscles. Both patients had persistent fever. The roentgenographically observed subluxation developed in one to two months after tonsillectomy. One of the patients was treated only with antibiotics; the other patient required atlantoaxial spondylodesis. Healing of the subluxation lasted about six months in both cases. (Arch Otolaryngol1981;107:181-182)

The responses to stimulation of upper cervical muscle and cutaneous afferents were studied in motoneurons innervating splenius, complexus, and biventer cervicis dorsal neck muscles of cats. Motoneurons innervating complexus and biventer cervicis fibers, which are in the deeper, longitudinally oriented muscles, were monosynaptically excited by ipsilateral Group I afferents from each of these muscles, but they did not receive significant input from splenius Group I afferents. Likewise, splenius motoneurons were not monosynaptically excited by ipsilateral afferents from complexus anf biventer cervicis. Stimulation of ipsilateral cutaneous afferents produced predominant excitation in splenius motoneurons, predominant inhibition in biventer cervicis motoneurons, and inhibition or mixed responses in complexus motoneurons. None of the neck motoneurons studied showed postsynaptic potentials following single or multiple shock stimulation of contralateral muscle nerves at stimulus intensities expected to excite exclusively Group I afferents. Higher intensity stimulation of contralateral muscle afferents, as well as fibers in the greater auricular nerves, produced predominant inhibition in all three neck motoneuron pools. Segmentally-excited afferents to neck motoneurons, like those from supraspinal systems, appear to evoke different patterns of synaptic responses in splenius motoneurons than they do in motoneurons innervating fibers in the deeper, longitudinally oriented complexus and biventer cervicis muscles.

Basic physical characteristics of the neck have been defined which have application to the design of biomechanical models, anthropometric dummies, and occupant crash protection devices. The study was performed using a group of 180 volunteers chosen on the basis of sex, age (18-74 years), and stature. Measurements from each subject included anthropometry, cervical range-of-motion (observed with both x-rays and photographs), the dynamic response of the cervical flexor and extensor muscles to a controlled jerk, and the maximum voluntary strength of the cervical muscles. Data are presented in tabular and graphic form for total range-of-motion, cervical muscle reflex time, decelerations of the head, muscle activation time, and cervical muscle strength. The range-of-motion of females was found to average 1-12 deg greater than that of men, depending upon age, and a definite degradation in range-of-motion was observed with increasing age. Average neck muscle reflex times range from 56-92 ms for flexors and 54-87 ms for extensors, with males being generally slower-reacting. This finding means that the cervical muscles generally cannot be activated in sufficient time to mitigate the hyperextension effects of a surprise rear-end collision. Reflex time becomes significantly longer after middle c.g. in the range of 0.3-0.5 g. The time required to stop the head after initial detection of the muscle reflex was slightly longer for neck extensors. Strength tests revealed that males are on average stronger than females in both flexor and extensor strengths. Males and females also exhibit different aging characteristics, and a slight stature effect was noted for the younger and shorter portions of the population. Age and sex were found to be important factors in cervical flexibility and response characteristics, and they should be included whenever accurate representation of neck parameters is desired.

This case is so unusual, both as to the etiology and the failure to recognize the condition for a long period, that it is well worth reporting. REPORT OF CASE A private, white, aged 22, a farmer before entering the Army, with negative family and past history, was admitted to one of the base hospitals, Dec. 19, 1917, suffering from measles and acute follicular tonsillitis. Tonsillectomy was performed, Jan. 16, 1918; the night of the operation the patient's neck suddenly became stiff, and had remained that way ever since. He arrived at General Hospital No. 6, in July, 1918, and the following brief history accompanied him: "1. Complaint: Pain in neck, stiffness of cervical muscles which permits of very little motion of the head, except anterior-posteriorly, which motion is limited. 2. Search for focal infection: (a) Tonsils (fragments); (b) roentgen ray, ostearthritis, first and second cervical vertebrae; (c) teeth, abscess

INTEREST in the allergic cause of various myalgias developed as a result of clinical observations on patients undergoing individual food tests 1 for the diagnosis of specific food sensitivity. Myalgia of the cervical muscles has been repeatedly observed to follow experimental ingestion of foods or exposure to inhalants in specifically sensitized persons. The facts that these muscular symptoms may be reproduced repeatedly and at will in experimental circumstances and that such complaints may be relieved by avoidance of incriminated allergens are the basis of the thesis that such manifestations are of allergic origin. The allergic response of skeletal musculature may be localized to regional groups of muscles, to a single muscle or, apparently, to a segment of a given muscle. In other instances the process seems to involve multiple groups of muscles, such involvement giving rise to the impression that the reaction is generalized in character. Of the various localized

In 1946 Stout published his classical paper 1 on rhabdomyosarcoma of skeletal muscles, which established, for the first time, the microscopic characteristics of sarcomas of skeletal muscles in the absence of demonstrable cross striations. Stobbe and Dargeon 3 pointed out, in 1950, that the embryonic type of rhabdomyosarcoma of the head and neck in children resembled neuroblastoma and lymphosarcoma. They reported 15 patients with a mean age of 6½ years but who varied in age from 16 months to 16 years; 13 of their patients were 12 years old or younger. In these cases limited to the head and neck, the primary rhabdomyosarcomas developed in orbital, facial, and cervical muscles. The authors state that clinically these tumors were rarely diagnosed early and were often misdiagnosed microscopically. Distant metastases occurred in several sites in 6 of 15 cases: lungs in 4 cases, pleuras in 3 cases, lymph nodes in 3, vertebral

Background Sensorimotor mechanisms are important for controlling head motion. However, relatively little is known about sensorimotor function in the cervical spine. This study investigated how age, gender and variations in the test conditions affect measures of position sense, movement sense and reflex activation in cervical muscles.

Up to 90% of people with neurological deficits following a whiplash injury do not recover and cervical muscle dysfunction is common. The aim of this multicentre, randomized controlled trial was to examine whether two versions of neck-specific exercise or prescription of physical activity (PPA) can improve radiating arm pain and clinical signs that can be associated with neurological deficits in people with chronic whiplash associated disorders (WAD). Participants with chronic WAD, arm symptoms and signs associated with neurological deficits (n = 171) were randomized to: 12 weeks of neck-specific exercise without (NSE) or with a behavioural approach (NSEB), or PPA. Pain/bothersomeness frequency, six measures of arm pain/paraesthesia (VAS scales), and four clinical neurological tests were evaluated after 3 months. The NSE group reported the lowest frequency and lowest levels of arm pain, the highest proportion of participants with at least 50% pain reduction and the highest proportion of normal arm muscle force. The NSEB group reported increased normal tendon reflexes. No improvements were recorded for the PPA group. Neck-specific exercise may improve arm pain and decrease signs of neurological deficits, but the addition of a behavioural approach does not seem to be of additional benefit.

Severe granulomatous lesions in cervical muscles and lymph nodes, associated with the use of an oil-based erysipelas vaccine, caused considerable economic loss at slaughter in 1400 pigs from the one herd. The condition was reproduced experimentally using the same vaccine, and in a less severe form with another commercially available oil-based erysipelas vaccine.

A severe spasmodic torticollis of five months' standing was at once relieved and has remained under control for a year and a half by the simple expedient of spring-pressure on the cervical muscles. For several weeks the spasm recurred on removal of the apparatus, but later no appliance was necessary. The affection was brought under control in spite of the existence of marked ocular defect. No drugs, no exercises, no massage or electricity, no complicated fixation apparatus were used in bringing about the desired result. A second severe case of spasmodic torticollis of five weeks' duration somewhat relieved at once, and in three months practically cured by the spring-clamp, supplemented by a careful system of gymnastics designed to relax as well as to develop all, muscles, and especially those of the neck. Very little attention was given to the development of the muscles directly opposed to those involved in the spasm. The exercises were designed to improve the general poise and to secure good muscular control throughout the body.

To the Editor.— Billiards may not look like a sport that could induce injury, but one case illustrates its danger. Report of a Case.— A 56-year-old man complained of tightness of the right cervical muscles and soreness of the right shoulder that occasionally interfered with sleep, was associated with brief morning stiffness, and was noted to be worse a day or two after playing pocket billiards, especially nine-ball. Muscular tenderness of the nuchal and trapezius muscles on the right side with trigger points at the base of the skull, the midtrapezius muscle, and anteromedial to the shoulder was present, as well as skinfold tenderness. Forced abduction produced a sensation of "pulling" in the shoulder. Treatment was successful with conditioning exercises, proper instruction in technique, massage of tender muscles, application of local heat, and more frequent participation in billiards. Therapy with muscle relaxants, anti-inflammatory drugs, and analgesics was not required. Comment.—

Torticollis (wryneck) is due to a spasmodic condition of the cervical muscles, chiefly those supplied by the spinal accessory nerves. The name is derived from two Latin words,tortus, twisted, andcollum, neck. The termstic rotatoire, Nickrampf, etc., are used as expressive of the spasm, muscles affected, tenacity, etc. This abnormal contraction of the cervical muscles is directly the result of irritation of the external cervical branch of the spinal accessory nerve, which having two different origins, a spinal and cerebral, has two distinct functions. The spinal or motor branch supplies the motor power to the sterno-cleido-mastoid and trapezius muscles, and communicates with the first, second, third, and fourth cervical nerves, its roots being traced between the anterior and posterior roots of the first five cervical nerves. As we have seen, wryneck proper is an affection of the sterno-cleido-mastoid and trapezius muscles, but in cases of long standing and