544: DISEASES OF THE ORGANS OF LOCOMOTION. 



tion, which is generally mild, and subsides in a few days, becomes 

 chronic, and may induce permanent shortening of the muscles in some 

 cases, which, however can hardly be distinguished from the previously 

 described spastic form of torticollis. Rheumatismus pectoris, or pleu- 

 rodynia rheumatica, occurs chiefly in the pectoralis major and inter- 

 costal muscles. In the former case, the movement of the arm forward 

 and motion of the affected muscular filaments are painful ; in the sec- 

 ond case, the respiratory movements, and especially coughing and 

 sneezing, as well as bending the thorax laterally, are so. From the 

 hinderance to the respiration, these patients look as if the pain were 

 deeper seated as if the lung or pleura were diseased ; and as mov- 

 ing the skin, fascia superficialis and pectoralis, does not increase the 

 pain, the physician also might be deceived, if moving the intercostal 

 muscles from before backward with the point of the finger did not ren- 

 der the pain unbearable, while laying the hand on the part and making 

 even pressure usually moderates it ; and if the absence of cough, and 

 especially the physical examination of the breast, did not confirm the 

 diagnosis. Rheumatism of the back, particularly of the shoulders, 

 omodynia rheumatica, is among the most 1 frequent forms of muscular 

 rheumatism ; it is easily recognized by the impaired motion of the 

 shoulder-blade and arm, as well as by the severe pain induced by mov- 

 ing the filaments of the trapezius, latissimus dorsi, and deltoid, or if the 

 deeper layer of muscles be affected by the stiff position of the patient, 

 and the severe pain induced by stooping. Painful affections of the 

 abdominal muscles occur chiefly after severe straining in coughing, and, 

 from their severity, may excite the suspicion of severe disease. Noting 

 the state of the pain on regular pressure over the abdomen, and on 

 movement of the muscular filaments, is the best means of avoiding 

 error. Rheumatism of the lumbar muscles and lumbo-dorsal fascia, 

 lumbago rheumatica, is remarkable for its severity and its frequently 

 very rapid occurrence. Not unfrequently, patients who, a few minutes 

 previously could move with perfect ease, cannot rise from their seat, 

 or at least suffer severely while doing so. When they go to bed, or 

 get up also, or even when they wish to sit up in bed, or on any at- 

 tempt to move the lower part of the spinal column, they make wry 

 faces, cry out, and place themselves in the most peculiar attitudes to 

 favor the painful parts, and attain their end without motion of these 

 parts. Hence, patients suffering this " witch's spell " (" Hexenschuss ") 

 excite laughter as well as pity. Lastly, all the muscles of the extrem- 

 ities may be attacked with rheumatism either individually or in groups, 

 so that sometimes one and sometimes another set of motions becomes 

 painful or impossible. 



TREATMENT. The same principles answer for the treatment of 



