PAIN IN THE MUSCLES, OR MYALGIA. 441 



suffer from a muscular pain, referred to a small spot about the size of a shilling 

 just below the breast, commonly the right The pain is pretty constant, slightly 

 relieved by the recumbent posture, but increased by lying on the affected side ; it 

 may come on during the third month and last to the time of confinement, and from its 

 wearing character is very apt to cause great depression. Another common seat of 

 muscular pain is in the lower part of the body in front, and it is then sometimes 

 erroneously supposed to arise from some disease of the bladder or womb. 



Pain in the back is a very common form of muscular pain. It is readily pro- 

 duced by a long ride on horseback, by a long stand in a crowd, by digging or 

 weeding in a garden, or by working in a position that requires much stooping. It 

 is sometimes brought on by railway travelling, or by having to carry a heavy infant 

 or other considerable weight for many consecutive hours. It is an accompaniment 

 of many diseases, especially of those which are not sufficiently severe to make the 

 patient lie up altogether, but are yet bad enough to considerably diminish the 

 strength. It is often a cause of infinite trouble to those whose occupations necessi- 

 tate the carrying on the head of heavy weights, such as water, stones, baskets of 

 fish, fruit, flowers, <fec., and is especially common in young men of all classes of 

 society, whose health has been lowered by an excessive discharge or other similar cause. 



Muscular pains under the collar-bones and over the front of the chest often 

 follow prolonged efforts at vomiting or fits of coughing. In women they are not 

 uncommonly produced by sewing, especially when the individual is unaccustomed to 

 the work, or when the material consists of some thick, heavy substance, such as 

 coarse calico, linen, or canvas. They are often associated with extreme tenderness 

 of the breast, and sometimes even with slight swelling. 



There is one form of muscular pain which, from the frequency of its occurrence 

 and the ease with which, on a superficial examination, it might be mistaken for 

 pleurisy, almost deserves a special notice. It is commonly known as pleurodynia, 

 and is an affection of the muscles of the side of the chest Many of us are 

 acquainted with it under the name of " stitch in the side," and are aware that it may 

 be produced even in perfectly healthy people, by running, or immoderate laughing, 

 coughing, or sneezing. It is very common in delicate women, and even in men 

 whose health has been reduced by an attack of illness or other similar cause. The 

 pain is often confined to the left side. It is always increased by taking a deep 

 breath, or by any movement which stretches the muscles. Before the introduction 

 of the clinical thermometer it was frequently by no means an easy matter to dis- 

 tinguish between pleurisy and pleurodynia or false pleurisy. Nowadays, in the 

 majority of cases little or no difficulty is experienced in making the diagnosis. 

 Pleurisy is attended with fever, whilst pleurodynia is a non-febrile disease. If we 

 take the temperature and find that it is not at all elevated, we may feel assured 

 that it is not pleurisy from which the patient is suffering ; but if, on the other hand, 

 the temperature is distinctly raised, we are certain that we have to do with some- 

 thing more than mere muscular pain. Of course, the patient may be suffering from 

 a cold, and this may be sufficient to cause the elevation of temperature, but the 

 exercise of a little judgment usually suffices to eliminate this or any similar source 

 of error. 



