MUSCULAR RHEUMATISM. 545 



muscular rheumatism that we laid down for that of chronic articular 

 rheumatism ; that is, in the fixed form the treatment must be rather 

 local ; in the wandering form, more general. But, as the former is 

 usually a milder and less obstinate disease than the latter, less ener- 

 getic treatment is necessary in most cases. The most successful local 

 treatment is abstraction of blood, by wet cups, if possible. The life- 

 invigorator (Lebenswecker) has, of course, just the same effect as cup- 

 ping ; formerly its effect in rheumatism was regarded, even by physi- 

 cians, as miraculous. The success of irritating liniments, blisters, sina- 

 pisms, plasters, gout-paper, or skins of animals, in muscular rheuma- 

 tism, is about the same as in articular rheumatism. Perhaps one of 

 the most effective, but at the same time most painful, rubefacients, is 

 the application of the induced current by means of the electrical brush. 

 The same is true of the use of the constant current in this affection as 

 in chronic articular rheumatism. I can fully confirm the brilliant re- 

 sults reported by Erb. Stroking and kneading the painful muscles, 

 which forms the regular business of some persons called " rubbers," is 

 one of the most efficient means of local treatment. Diaphoresis is the 

 most reliable constitutional remedy. Treatment by baths is rarely 

 necessary, and is so only in obstinate cases which are usually compli- 

 cated with chronic articular rheumatism. A few cups of elder-blow 

 tea, or some warm drink, and plenty of blankets over the patient to 

 excite profuse perspiration once or twice, usually improve or remove 

 muscular rheumatism. In recent cases a vapor-bath often gives in- 

 stant relief ; and although I have spoken against the continued use of 

 vapor-baths in chronic articular rheumatism, I can recommend the trial 

 of one or two in recent cases of muscular rheumatism. 



CHAPTER V. 



GOUT POD AGE A ARTHRITIS. 



ETIOLOGY. There is scarcely any disease that shows so great a 

 similarity of symptoms at the commencement of all cases, and which 

 consequently is so markedly a peculiar disease, as gout. It is true, 

 old cases may resemble other diseases, particularly rheumatism ; but, 

 in such cases, it is only necessary to inquire about the commencement 

 of the affection, in order to prevent its being mistaken for rheumatism. 

 But although it is certain that gout is a peculiar form of disease, and 

 although constant chemical changes have been observed in the blood 

 of gouty patients (Garrod], and uric acid, the substance which is in 

 excess in the blood, has been found in the products of gouty inflam- 

 mation, still we have no exact knowledge of the pathogeny of this 



