MUSCULAR RHEUMATISM. 543 



may refer to what we have said of the etiology of acute and chronic 

 articular rheumatism, and the more so as muscular rheumatism is very 

 often complicated with the articular form of the disease. Catching 

 cold is certainly the most frequent cause ; but the sudden occurrence 

 of some forms, as lumbago, renders it very probable that, besides catch- 

 ing cold, there are other causes, especially straining or fatigue of the 

 muscles, etc. 



SYMPTOMS AND COURSE. The most important, and usually the 

 only symptom of muscular rheumatism, is the pain which is generally 

 designated as stretching or tearing. Moving or rubbing the affected 

 tissues increases this pain, while regular pressure generally diminishes 

 it. Occasionally the pain is accompanied by inability to shorten the 

 affected muscle, and to make active movements with it. The skin 

 covering the part does not appear red and swollen, or warmer than 

 the surrounding parts. The pain usually exacerbates toward evening, 

 and remits in the morning. It is generally made worse by cold and 

 dampness, and improved by dry warmth. But sometimes the warmth 

 of the bed increases rheumatic pains. Occasionally muscular rheuma- 

 tism is " wandering," that is, the pain leaves one place and appears in 

 another. Sometimes it remains " fixed " in certain muscles, fascias, 

 etc. In most cases muscular rheumatism is an acute disease, which 

 entirely disappears after a short duration ; rarely it is a chronic affec- 

 tion, and either the wandering or fixed form may become chronic, just 

 as wandering or fixed articular rheumatism does. According to its 

 location, muscular rheumatism has received various and sometimes pe- 

 culiar names. If the frontal, occipital, or temporal muscles, the galea 

 aponeurotica, or the periosteum of the skull be affected, we term it a 

 cephalalgia rheumatica. We should make it a rule not to misuse this 

 name, and in each case, before making a diagnosis of cephalalgia rheu- 

 matica, to determine carefully if the above tissues be really the seat of 

 the pain, whether movement of their fibres or contraction of the muscles 

 increases the pain, and, finally, whether the affection be primary and 

 idiopathic. Rheumatism of the head is most readily mistaken for neu- 

 ralgia, or syphilitic periostitis. It is a very common, bad habit, to 

 ascribe to rheumatism the numerous cases of severe and obstinate 

 headache whose true cause we cannot discover. The laity, who do 

 not make any great distinction between rheumatism and gout, gener- 

 ally call all obstinate headaches gout in the head. If the muscles of 

 the neck be affected with rheumatism, the movements of the head be- 

 come painful ; the patients fear and shun them. There is " stiff neck," 

 an affection which complicates many cases of angina faucium. If the 

 muscles of only one side of the neck be affected, the head is held con- 

 stantly lo one side ("wry neck," torticollis rheumaticus). This affec- 



