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Muscular Rheumatism.

Problems:

Synonym:—Myalgia.

Definition:—A condition in which there is more or less permanent soreness, stiffness, and perhaps sharp, acute pain in the structure of the muscles, especially of the deep muscles of the body, which ultimately extends to the fasciae and to the periosteum of the bones. Situated in the muscles of the chest this condition is known as mastalgia. In the deep muscles of the loins, it is called lumbago; in the muscles of the neck, it is called torticollis.

It has only been a few years that this condition has been acknowledged as having a right to separate recognition as an independent condition. The writer has had a protracted personal experience which gives to him a clear conception of its character.

Etiology:—This disease arises from the persistence of those conditions which induce rheumatism elsewhere in the system, from the presence of uric acid diathesis, and is coincident with lithemia, and is undoubtedly an indirect or remote result of autotoxemia. It is induced by exposure to cold and damp; patients suffering from the conditions above named are enabled to foretell with startling accuracy changes from warm and dry, to cloudy and damp weather. It occurs in both sexes and at all times of life, above infancy. While it is often classed as neuralgic in character, this is frequently denied; and yet I am sure that the condition of the nervous system has much to do, in many cases, with the occurrence of this disorder. It occurs frequently in neurasthenics and in hysterical patients, and in those who have a predisposition to neuralgic attacks.

Symptomatology:Muscular stiffness and local pain in a circumscribed area are the commonest symptoms. There are remissions or intermissions for a considerable period, or exacerbations during the presence of this condition, with all patients. There is tenderness on pressure over the sore muscles, and if a mild current of electricity be passed over the affected area, the tenderness is found to be increased. A mild faradic current passed over those portions of the muscular structure which are thought to be free from the disease will often discover acutely sensitive areas in which the disease may ultimately develop. Pain in the muscles of the chest interferes materially with the respiration and is exceedingly annoying, although it does not materially affect the general health of the patient. When over the left side of the chest, it is often mistaken for cardiac pain, and is thus often the cause of much anxiety.

Torticollis occurs suddenly after prolonged exposure to cold, especially when the back of the neck is exposed. The manifestation, acute in form, lasts for a period of from five to ten days, during which time the pain is sometimes excruciating, inducing an absolute inability to move the head. At other times, without acute manifestation, there is permanent soreness at the attachments of these muscles and in the tendons, and also in the periosteum of the bones, which interferes with the movements of the head, and results in more or less crepitus, which may be constantly apparent to the patient, and is annoying indeed.

Lumbago is apt to occur after violent muscular exertion, as when from sudden lifting of a heavy weight, or when a quick, violent strain is thrown upon the muscles of the back. This abruptly incapacitates the patient for any muscular exercise for hours, or perhaps days. Extreme soreness develops in the deep lumbar muscles and every motion causes pain. The condition slowly disappears, but for a long time there is weakness in the muscles of the back; the patient constantly dreads an occurrence of the pain, and his anxiety is increased by occasional shooting, stich-like pains in these muscles. For months after the patient believes himself cured the faradic current will find undue sensitiveness over the affected area. So closely do these two latter conditions resemble neuralgia that the writer has no doubt in his own mind that the nerves are directly involved in the disease. I am convinced of this also by the efficient action of gelsemium with macrotys in the treatment.

There are other muscles in which this disease is occasionally located, such as in the muscles of the scalp, the thick muscles of the arms or thighs, and occasionally the muscles of the abdomen. It may involve also the pleura and the peritoneum.

Diagnosis:—Diffused soreness of the muscles on pressure over a given area, with the occurrence of occasional sharp, lancinating pains in the absence of chill and fever, are diagnostic indications. There are but few conditions with which it will be confounded. Except in the pleural and peritoneal forms, which may be taken for acute inflammation, the absence of fever will assist in a correct differentiation.

Treatment:—I have obtained excellent immediate results in all of these cases by covering the parts with a fold or two of warm flannel, and slowly and steadily ironing the part with a hot flat-iron for a period of from ten to twenty minutes, repeated perhaps three times each day, or oftener if desired, and continued after the acute symptoms have subsided. This simple measure must be thoroughly tried to establish confidence, but in many cases nothing I have used in thirty years' experience has been so highly gratifying to the patient. The heat should be as intense as can possibly be borne, and may be modified by increasing the number of layers of flannel between the iron and the skin.

For internal treatment, cimicifuga and gelsemium are the specific remedies. The former exercises its direct influence upon the muscular structures, and the latter upon the nerve filaments, and at the same time they influence the central nervous system, stimulate the general elimination, and materially encourage elimination through the kidneys, thus relieving capillary constriction and local irritation in these organs, which is so common in rheumatic conditions, and promoting a free flow of the watery portion of the urine. In pleurodynia and in affections of the peritoneum, bryonia and asclepias are indicated by the soreness in these serous membranes and by the sharp, cutting pains. In an abrupt attack of lumbago it is good treatment to apply dry cups over the muscles, if the pain will permit, before the ironing process is adopted, but this course, although sometimes productive of immediate relief, is usually objected to.

I have seldom failed to obtain permanent results from the mild faradic current, as advised in chronic rheumatism. It has been my habit to use this current over the affected muscles in conjunction with internal medication, twice a day during an acute attack, and every second or third day for weeks succeeding an attack, until no muscular soreness was complained of, even when the current was increased to considerable strength. I am confident that there is but little danger of a recurrence of attacks which are treated with electricity.

These patients, like chronic rheumatics, should be put upon a vegetable diet, with a large quantity of pure water, or upon a free milk diet, and should form habits of eating which conduce to the absorption and rapid appropriation of the nutritious elements with the least possible errors of metabolism, and everything should be done to encourage elimination. Hot baths are of immense service, and anything that will promote free perspiration will cause the patient to remark concerning his temporary well being. Immediate relief is often experienced from a free sweating. The condition of the stomach should be kept as near as possible to the normal point, and any faults of the nervous system should be overcome, especially any tendency toward nervous debility, which should be promptly restored by correctly adjusted tonics.

These patients do much better in a warm climate or during hot weather in cooler climates. They suffer more during cold weather, and are unable to resist cold, readily becoming chilled. They always express themselves as enjoying better health during the heat of the summer. This is due to the greater freedom of cutaneous transpiration and general elimination at that time.


The Eclectic Practice of Medicine with especial reference to the Treatment of Disease, 1910, was written by Finley Ellingwood, M.D.



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