542 DISEASES OF THE ORGANS OF LOCOMOTION. 



TREATMENT. Little hope as we have of removing by treatment 

 the deformity that has once developed, I cannot agree with those 

 authors who say that treatment is entirely useless in arthritis defor 

 mans. The impairment of motion does not usually depend solely on 

 the deformity, but to a considerable extent also on the still existing 

 inflammation. The remedies which we placed in the first rank against 

 chronic articular rheumatism, particularly the warm baths and the 

 painting with tincture of iodine, have in many cases at least a favor- 

 able effect on the inflammation. Every season at Toplitz, as I actu- 

 ally know, and probably also hi the other watering-places mentioned 

 in the preceding chapter, some patients with arthritis deformans have 

 improved so much that they were able to leave the chair with rollers, 

 a,nd after the termination of their treatment could roll other patients 

 to the baths. 



CHAPTER IV. 



MUSCULAR RHEUMATISM RHEUMATISMUS MUSCULARIS. 



ETIOLOGY. Under the term muscular rheumatism it is customary 

 to class not only rheumatic affections of the muscles, but also those of 

 the fascia, periosteum, and other fibrous tissues, except those about 

 the joints. The changes induced in these tissues by rheumatic affec- 

 tions are not exactly known. The negative results of most autopsies 

 seem to render it very probable that the anatomical changes are of 

 that class that leave little trace in the cadaver, that is, that they consist 

 chiefly in hypenemia and scanty serous exudations. In rare cases, how- 

 ever, the rheumatic process appears not to be arrested at this point, 

 but to lead to inflammatory proliferations of connective tissue. Fro- 

 riep and Virchow found places in the muscles where the muscular 

 tissue was replaced by callous connective tissue (rheumatic callosities), 

 and Vogel observed thickenings and adhesions of the neurilemma of 

 the corresponding nerves in several cases of chronic rheumatism. 

 These cases are so rare compared with those where no changes can be 

 discovered, that it is hazardous to base a definition of rheumatic affec- 

 tions on them. Even supposing that hyperaemia and serous exuda 

 tions, and in severe cases an inflammatory proliferation of connective 

 tissue, be the basis of the rheumatic affection, it still remains undeter- 

 mined whether the sensory nerves traversing the muscles are morbidly 

 excited by changes in the muscles and sarcolemma, or by simultaneous 

 changes in their neurilemma. In the latter case, muscular rheumatism 

 would be a so-called rheumatic neuralgia of the small nerves supply- 

 ing the muscles. Regarding the etiology of muscular rheumatism, we 



