BHEUMATI8M, MUSCULAR. 483 



RHEUMATISM, MUSCULAR, 



This Is a complaint which is usually regarded as being closely allied to rheumatism 

 of the joints, the difference in the symptoms being supposed to depend on the pecu- 

 liurities of the structures which are affected in the two diseases. Doubt has, 

 however, been thrown upon the correctness of this opinion from the circumstance 

 that the complaint now under consideration is never complicated by any disease of 

 the heart or of its membranes. 



Muscular rheumatism usually commences as an acute disease, but exhibits a 

 decided tendency to become chronic. It may affect any of the muscles of the limbs 

 or trunk, but is far more likely to occur in certain situations than in others. The 

 seizures are not uncommonly quite sudden for example, the patient may find on 

 awaking in the morning that he is unable to make a certain movement, or to 

 perform some particular act, without experiencing the most exquisite pain. Usually 

 there is no pain whilst the muscles of the part are quiet, but the slightest movement 

 suffices to excite a paroxysm. On examining the seat of suffering, nothing can as 

 a rule be detected, but sometimes there is slight tenderness on pressure. There is 

 often no fever or constitutional disturbance at all events at first ; but as the 

 complaint progresses there may be thirst, loss of appetite, and even considerable 

 elevation of temperature, as the result of the long-continued pain, and the want of 

 sleep which it occasions. , 



We know very little respecting the causes of muscular rheumatism. It is most 

 commonly met with in people of full adult age, and not uncommonly in individuals 

 of a gouty habit. Exposure to cold and damp, and the over-use of the affected 

 part, may act as exciting causes. One attack of the disease engenders a liability to 

 its return. 



The duration of the complaint cannot be definitely fixed. As an acute disease it 

 is usually of brief duration, but in the chronic forms it often proves very rebellious 

 to treatment, and its duration may bo protracted almost indefinitely. 



Muscular rheumatism is not confined to any particular region of the body, but 

 may occur in almost any locality. The principal varieties are lumbago and crick in 

 the neck, and we shall speak of the treatment of the complaint under these two 

 headings : 



A. Lumbago. This is a rheumatic affection of the muscles of the loins, those 

 on one or both sides being involved. It is frequently very sudden in its mode of 

 onset, the pain seizing the patient "all of a moment." The pain is usually 

 increased by every movement of the lower part of the spine, and by pressure upon 

 the muscles of the affected part. It is not uncommon to see patients with lumbago 

 leaning forwards and walking almost double. If they are told to " touch their 

 toes" they generally express their inability to do so, although in many cases it 

 appears on investigation that the pain is caused not so much by bending down as 

 i>y the effort to get up again. Sometimes, however, the mere effort of stooping is 

 very painful. We remember being told by a hospital patient a story which forcibly 

 illustrates this fact. He was a butcher by trade, and his lumbago had been caused 

 by lifting heavy weight? and carrying the carcases of sheep, bullocks, &c., on his 



