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pains, muscles, affection, muscular, pain, chronic and usually

RHEUMATISM, MUSCULAR.—An affection characterised by muscular pains and by disturbances of motility. Pain is a signal that some part of the body is not in harmonious relation with its inner or outer environment. Simple pains, which are very prevalent, are usually designated as rheumatic, and ascribed to slight colds. In many cases, however, this assumption is a great mistake, which often causes a serious affection to be overlooked, so that proper treatment is not procured in time.

It is possible that pains which are rheumatic in character may be caused by diseases that have nothing whatever in common with rheumatism. Many neuralgic-like pains are present as a result of syphilis, alcoholism, lead-poisoning, sciatica, nervous affections, inflammatory conditions of muscles or of the periosteum (the membrane which invests and nourishes the bones), incipient diseases of the vertebra, and abdominal disorders of women. See also LUMBAGO. It is necessary, therefore, to have a physician determine the cause of the pains in order that the condition may be treated correctly.

Muscular rheumatism—so-called—is really a muscle-disease rather than a nerve-disease. It is a true myalgia (from Greek mys, " muscle " and algos, " pain ") in distinction from a neuralgia (from Greek neuron, "nerve " and algos).

Two forms of the affection are distinguished—the acute and the chronic The principal symptoms in both forms consist in pains and disturbances of movement. In the acute form the affected muscle is usually slightly swollen and sensitive to pressure ; whereas demonstrable changes are generally absent in the chronic variety. For this reason, patients suffering from chronic muscular rheumatism are often wrongfully suspected of malinger ing. As a rule the disease attacks one muscle or one group of muscles, and the pain rarely wanders between unassociated muscles. Fresh cases almost invariably pursue a rapid course (a few days) ; but there are also obstinate forms which, although they cause only insignificant disturbances, are aggra vated by changes in the weather. These patients are, therefore, often termed " human barometers." Muscular rheumatism is most frequently located in the muscles of the loins (in the small of the back), and is then called LUMBAGO. The affection

has an acute onset, without any apparent cause. The patient suffers violent pains in the lumbar region, which are intensified by every movement of the trunk, such as bending, turning, or raising the body. Lumbago is very often brought on by lifting a heavy weight or by rapid bending of the body. Other favourite scats of muscular rheumatism are the nape of the neck, the shoulders, the chest, and the head. Mvalgia in the back of the neck may affect the muscles of one or of both sides. In the latter case the head becomes stiff and immovable ; in the former, it is inclined toward one side. When the shoulder is the seat of rheumatism, the arm cannot be raised. Rheumatism of the chest causes intense pain on breathing, coughing, and sneezing. Occasionally this condition is erroneously regarded as an incipient inflammation of the pleura or intercostal pains. Rheumatism of the head, in which different muscles of the face and of the scalp are affected, causes headache. Moving the scalp (as by wrinkling the brows) is particularly painful. Rheumatism of the abdominal muscles is occasionally noted in wandering musicians.

The use of internal medicines (salicylic acid, etc.) at the beginning of the affection is usually followed by rapid recovery. Sweat-cures (steam-baths, etc.) are also of great service. Massage, correctly given, likewise removes the pain, often as if by magic. If the affection run a more protracted course, the remedies employed in the treatment of chronic articular rheumatism are to be considered. These include embrocations, mustard-plaisters, elec tricity, gymnastics, baths, etc.

RHUBARB.—The root of several species of Rheum, plants growing in Tibet. In the markets it occurs as hard, round, gritty pieces, brownish in colour, and having a bitter taste. Rhubarb is a laxative which acts by increasing the flow of bile and stimulating the intestine ; but it is apt to be followed by constipation, owing to the presence of tannic acid. For this reason it is a good drug with which to empty the bowel in irritative diarrhoea. It is given in many preparations.