From observations of two hundred cases of muscular rheumatism, it is con cluded that both muscular and articular rheumatisms are infectious and prob ably caused by an attenuated form of micro-organism. W. Leube (Dent. med. Woch., Jan. 4, '94).
The entrance of a particular attenu ated pyogenic organism, invading the tissues through the tonsils, may be the common cause of simple catarrhal an gina, or articular and muscular rheuma tism, and of the cutaneous manifesta tion observed in the course of these af fections. In addition, many other influ ences are in action, such as constitu tional peculiarity and bad hygienic con ditions. The difference in the particular symptom which may arise depends, on the one hand, upon the virulence, more or less marked, of the organism, and, on the other, upon the resistance offered by the structures. Peltessohn (Archiv f. Laryn., etc., vol. vii, Tome v, '97).
Treatment.—For internal use salicylic acid and its compounds are much em ployed and will sometimes, but not in all cases, bring relief. When the salic ylates fail to effect a cure, tincture of colchicum or iodide of potassium may be tried. Externally tincture of iodine and all the rubefacientia — ammonia, camphor, turpentine, etc. — are to be tried; also warmth in the form of hot water, poultices, and hot baths (Russian or Turkish). Of late hot-air baths have been much recommended. The external use of methyl-salicylate often alleviates the pain.
When the disease has passed over to the chronic stage massage and electricity are useful. In cases attended by indura tion and fibrous nodules in the muscles, characterized often by continuous and very intense pain, excision of the hard nodules of fibrous tissue often gives im mediate relief.
Massage recommended in muscular rheumatism. Recent eases are almost invariably cured by a few massages, while in more chronic cases relief will be hastened by the addition of rest, warmth, and electricity. Douglas Gra ham (Amer. Jour. of Med. Sci., Aug., '93).
Injections of sodium iodate given in a single injection of 7 to 15 grains, in troduced at the site of pain in the form of a 5-per-cent. solution, is usually fol
lowed by prompt relief. Care should bo taken to have both salt and solution as fresh as possible to avoid free iodine irri tation. S. Otto (Ther. Monats.„ Apr., 1900).
Gonorrhoeal Rheumatism.
Definition. — An acute inflammation of one or more articulations occurring during the course of gonorrhoea and caused by invasion of gonococci in the joints.
Symptoms.—Gonorrhccal rheumatism ordinarily appears in the acute stage of the gonorrhoea. In some cases the lesion of the joints is only revealed by arthral gia: i.e., intense pain without swell ing. This affection is particularly ob served in the small articulations of the foot. The pain is worst in the evening and is aggravated by movements. The arthralgia may also precede the evolution of the gonorrhoeal arthritis or continue for some time after the disappearance of the swelling.
In other cases the affected joint be comes the seat of an effusion of fluid, giving rise to no pain or accompanied by very little pain. This effusion dis appears very slowly and often leaves a stiffness or fibrous adhesions in the joint. This form of the disease is most fre quently observed in the knee.
Ordinarily gonorrhoeal rheumatism in its mode of invasion and evolution re sembles very much the acute form of articular rheumatism. It differs from that disease by attacking only one or a few articulations at the same time; the affected joints remain involved for a longer time. Again, gonorrhceal arthri tis does not migrate co suddenly from one joint to another as the acute articu lar variety. No joint, however, is im mune, and even those which ordinarily escape during the course of rheumatic fever, as, for instance, the articulations of the jaws and the neck, may be at tacked by the gonorrhoeal arthritis.
The pain is of extreme intensity. It is aggravated by movements and by pressure over the swelled articulation.
Many painful points are also found. The tumefaction is ordinarily very marked; it is caused as well by effusion into the joint and by oedema of the over lying coverings. The skin over the af fected joint is hot and tense.