Eclectic Medicine Part 6

8/2/2019 Eclectic Medicine Part 6

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P ART VI.CONSTITU TIONAL DISE ASE S.

DIABETE S MELLITUS.

S y n o n y m s .Saccharine Diabetes; Glycosuria.

Def in i t ion .A cons titut iona l disorder of nu tr ition, char acter ized by th epersistent presence of grape sugar in the urine, by polyuria, andprogressive loss of flesh a nd st ren gth .

Et i o l o g y .Predisposing Causes.

Geographical Location .While diabetes is found in every country it ismore prevalent in certain localities, though the reason has not beensatisfactorily explained. It is quite common in Southern Italy, India,Sweden, and Germany, and may depend to some extent upon diet,ha bit, cust om, and en vironmen ts.

Race.The r acial peculiar ities of the Hebrews m ay figure somewha t intheir susceptibility to diabetes, though the cause is obscure. We onlyknow that it occurs more frequently among the Jews than any otherrace.

S ex.Of thirteen hundred cases reported by Frerichs and Seegen, ninehundred and eighty-eight occurred among males, and three hundredand fifty among females, showing a strong sexual predisposition infavor of ma les.

Age.While it h as been observed from in fancy to old a ge, its occur ren cebefore puberty is quite rare, and after the age of sixty-five, the mostsu sceptible period being from t he age of fort y-five to sixty. In women itis ap t t o occur a bout t he change of life.

Heredity .The frequency with which diabet es occur s in certa in familiesma kes it appa ren t t ha t h eredity plays some par t a s an et iological factor,thus Seegen found it in fourteen per cent of his cases, Schmitz intwen ty per cent , and Boucha rd in twent y-five per cent . (Von N oorden.)

S ocial Position and Occupation.That diabetes occurs far more

T h e E c l e c t i c P r a c t i c e o f M e d i c in e - P AR T V I - C o n s t i t u t i o n a l D i se a s e s - P a g e 1The Southwest School of Botanical Medicine http://www.swsbm.com
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frequently among the wealthy and cultured, and those who lead aluxurious life, than among the poor and hard-working class, is theobservat ion of all practit ioner s of experience. That occupa tion favors t hedisease is sh own by t he frequency with which it is seen in t hose whosework is largely intellectu al, as t eachers, scientists, poets, st at esmen , and

th ose of th e learned profession.

Exciting Cause.The specific cause or causes have not yet beendetermined and a variety of theories have been advanced as to itsorigin. Extirpation of the pancreas or loss of function of this organ bydisease or morbid growths, results in diabetes, and hence it seemsprobable tha t t his organ plays some import an t pa rt as a cau sal factor.

Whenever the glycogenic function of the liver is disturbed, either byorganic disease of the organ or by a disturbance of its innervation by

puncturing the floor of the ventricle or section of the pneumogastric,diabetes follows. Tumors of the brain, concussion, hemorrhage, shock,grief, severe mental exertion, or, in fact, whatever produces adisturbance of that portion of the medulla that presides over theglycogenic funct ion, gives rise to diabetes.

Certain drugs produce glycosuria, notably phloridzin, chloroform, andpota ssium bromide. Obesity and dia betes ar e so often foun d in t he sa meperson a s to su ggest a close rela tion as to cau se and effect. An effort ha sbeen made to associate the infectious fevers with diabetes, but in all

probability such cases are coincidences rather than causes, and theinfectious disease, by weakening the system, revealed the diabeticcondition that was present previous to the attack. More recently themicrobic th eory has obta ined some support .

P a t h o l o g y .Various lesions and degenerations are found in thevarious organs of the body, but how many are causal and how manythe consequence of disordered nutrition would be hard to say. Thepan crea s is affected in m ore t ha n h alf th e cases. There m ay be at rophy,interstitial pancreatitis, and obstruction of the duct, cysts following

obst ru ction from calculi or growth s.

The liver is usually enlarged, showing fatty degeneration; sometimesinterstitial hepatitis prevails, and again abscesses are observed. Thespleen is usually atrophied. The heart is pale, flabby, and there may befatty degeneration. Pericarditis and endocarditis have been noted, and

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arterio-sclerosis is not a rare condition in diabetes. The lungs share inthe general breakdown, and gangrene frequently follows pneumonia.Tuberculosis of the lung is not uncommon. Pleural effusions aresometimes found.

The kidneys are enlarged and show fatty or hyaline degeneration.Int erstitial nephr itis is frequent ly present.

Var ious cha nges ar e seen in th e brain an d cord. There m ay be soften ingor thickening of the membranes, but the most constant lesions presentare those affecting the medulla or fourth ventricle. The blood contains alarger per cent of sugar th an during hea lth. There is genera lly extr emeemaciation, although in some cases the subcutaneous fat is found inconsiderable quantities. A bronzed condition of the skin is notuncommon.

The eye is usually involved in the advanced stages; cataract attackingby preference young subjects. Of retinal changes, Von Noorden, in TheTwentieth-Centurv Practice, says: Those which are dependent upondiabetes occur under three forms: (a) Albuminuric retinitis,accompanying contracted kidney, present as a complication or sequel ofdiabetes; (b) Retinitis centralis punctata, with characteristicophthalmoscopic changes (small, shining central spots, usually withhem orr ha gic puncta, a lways bilater al, with out involvement of the opticnervesLeber, Hirshberg); (c) Retinitis hemorrhagica of the ordinary

type.

S y m p t o m s .Two varieties are seen, the acute and the chronic. Thegeneral symptoms are very much the same in the two forms, theprincipal points of difference being in the age of the subject and themethod of onset of the disease; the acute, usually occurring in childrenand young adults, while the chronic form occurs most frequently afterthe age of fifty. The acute form comes on more rapidly than the chronicform; the latter comes on so slowly and insidiously that the disease iswell advanced before the patient is aware that he is its victim. Among

th e first symptoms th at a tt ra ct th e att ention of th e patient is that he islosing flesh and strength, and that he has frequent calls to void water,and in the morning he is surprised to find so large a quantity in thevessel. There is no pain save a weight in the loins, and the appetite isgood; indeed, in many cases, it is voracious. Digestion seemsunimpaired, yet the patient continues to grow thin, and prostration is



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ma rked; muscular weakness is char acteristic.

Thirst is a cha ra cteristic symptom, th e pat ient drinking lar ge qua nt itiesof water during both day and night. The large quantity of water seemsto be necessary to hold the sugar in solution for excretion, the demand

for water beginning an hour or two after a meal. The quantity of waterconsu med ha s a direct ra tio to the qua nt ity elimina ted.

The skin may be doughy and relaxed, although usually it is dry, harsh,and constricted. Pruritus is a distressing symptom, and is especiallyaggrava ted a bout th e genita ls, when t he diabetic ur ine comes in cont actwith t he pa rt s. Boils, car bun cles, an d eczemat ous eru ptions ar e comm on.The hair becomes dry, and loses its gloss, and the nails become brittlean d easily broken.

The tongue is dry, red, and glazed, or covered with dark sordes. Themouth is dry a nd sticky an d t he secretion of saliva is diminished.

The urine varies in quantity from four to twenty pints, although in rarecases it may be normal in quantity. It is pale, almost as clear as water,and has a specific gravity, ranging from. 1,025 to 1,050, although inrare cases it may go as low as 1,013. It has a peculiar sweet odor andtaste, and an acid reaction. Albumin is sometimes present before sugarappea rs in t he u rine, an d ur ic acid is foun d in excessive quan tities.

Tests for Urin e.See Glycosuria.

Pulmonary Complications.These are not uncommon in the advancedstages, pulmonary tuberculosis being quite frequent, and pneumonia isoften seen. The special senses may become impaired; thus the visionbecomes disordered, not only by a weakening of the muscles ofaccommodation, but also in some cases by cataract formation. Otalgia,otitis m edia, an d m ast oid affections occur . The sen ses of ta ste an d sm ellar e a lso affected in some cases.

Diabetic coma occurs in about half of the fatal cases. It may come onsuddenly but a few hours before death, or it may be announced by apeculiar fruity odor of the breath, gastric disturbance, and headache.Em aciation is quite r ap id after th ese symptoms, an d deat h soon follows.

Peripheral neuritis, characterized by. neuralgia and a numb, tingling

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sensation is not uncommon, while diabetic tabes may occur, and ischaracterized by darting pains, absence of the knee-jerks, and loss ofpower in the extension of the feet, giving the peculiar tabeticgaitsteppage.

The cour se of th e disease var ies according t o th e age of th e pat ient a ndthe form of the disease. Thus in the young, and in the acute form, thedisease last s from a few weeks t o two year s, while in t hose past middlelife an d wher e th e pat ient is obese, the disease m ay lasi for year s.

D i a g n o s i s .The diagnosis is very readily made; muscular weaknesswithout apparent cause, the passage of large quantities of water,itching of the genitalia, loss of flesh and strength, great thirst, hunger,and loss of sexual power, are so characteristic of diabetes that anan alysis of th e ur ine will scar cely be necessar y for a positive diagnosis.

P r o g n o s i s .Diabetes is a very gra ve disease, an d a lthough some casesrecover, a large per cent will terminate fatally. A complication thatfrequent ly car ries off the pa tient is pulmonar y pht hisis.

T r e a t m e n t .The treatment may be divided into three parts: Dietetic,hygienic, and medicina l.

Dietetic.Since the greater portion of glucose that enters the blood isderived from the carbohydrates, sugar and starch, such articles of food

as are rich in these substances should be excluded from the patient'sdiet. Saccha rin a nd glycerin h ave been recomm ended a s a su bstitu te forsugar , but th e ta ste is so disagreeable to most persons, tha t it can n ot besubstituted to any great extent. The following articles are to beprohibited: Such fruits and vegetables as are rich in starch and sugarsh ould be res t ricted, an d include th e following:

VegetablesPotatoes, rice, beans, peas, carrots, beets, onions, lentils,turnips, squash, tomatoes, asparagus, parsnips, artichokes, corn,hominy, sago, ar row-root, oatm eal, an d cracked whea t.

FruitsBananas, pears, grapes, apricots, apples, plums, strawberries,ra spberr ies, gooseberr ies, sweet cherr ies, figs, and chest nu ts .

Meat sLivers of an ima ls, mollusks (oyster s, clam s, etc.), and t he insidemea t of clams an d lobster s.

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FluidsSweet wines, chocolate, and cocoa, if sweetened, lemonade,beer, cider, champagne, and aerated drinks, such as ginger-ale, root-beer, et c., and a lcohol.

Foods Perm issible.VegetablesCucumbers, water-cresses, lettuce,cabbage, sorrel, mushrooms, spinach, celery, chicory, and variouspickles, unless sweet.

FruitsLemons, oranges, currants, grape-fruit, and nuts (chestnutsexcepted).

MeatsAll kinds of fresh meats, poultry, fish, game, bacon, ham, andlarge qua nt ities of fat , butt er, eggs, and cheese.

BreadThe crust, thoroughly toasted, of a French roll and glutenbiscuit.

BeveragesCoffee and tea, if not sweetened, sweet milk, buttermilk,plenty of pur e water, an d th e alkaline m ineral waters.

By observing a diet of this kind, the sugar is reduced to the minimuman d often disappear s. We ar e to remember, however, tha t th e str engthof the patient must be maintained, and many times we will have tomodify our diet and permit, in moderate quantities, articles on the

above-mentioned restricted list. We are not to sacrifice the strength ofth e pat ient by a t oo rigid diet.

Hygienic.The patient should take light exercise in the open air, and,when too weak to do this, should be well massaged; daily baths, hot orcold, according to the strength and age of the patient should be taken.The sleeping apar tm ent should be well ventilated a nd flan nels worn th eentire year. All mental worry and excitement should be avoided, and,where possible, th e pa tient should live in an equable clima te.

Medicinal.The medicinal treatment of this disease has not been verysuccessful. Von Noorden says, The number of drugs which have beenrecomm ended in th e tr eat men t of diabetes is legion; th e evidence of thesmall benefit of any individual, one. Of syzygium jambolanum (thebark and seeds of the Java plum) which have been so highly extolled,he says, I have never seen any results worth mentioning from the use

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of this drug. The agents most frequently employed are iron, opium,ar senic, nitra te of ur an ium, creosote, an d t he br omides.

Lycopus.In 1873, Dr. D. Ray read a paper before the Yolo County(California) Medical Society, on Diabetes, recommending lycopus. He

sa ys of a case, For weeks I h ad given h er iron, opium , bit ter tonics, andast ringent s, with a h ost of th e remedies recomm ended by aut hors, fromDr. Prout down to Flint, and without any benefit, when my attentionwas called to bugle weed as a n a gent for dia betes. The adm inistr at ion offluid ext ra ct of bugle weed, a tea spoonful five tim es a day, soon effecteda cur e. Since th en other s h ave reported favora bly upon its u se.

Rhus Aromatica.Dr. Goss in his Practice of Medicine, speaks highlyof th is agent in th e trea tm ent of diabetes.

Chionanthus.Dr. Hauss read a paper at the National Association in1901, extolling the virtues of chionanthus in this stubborn disease. Astudy of Eclectic remedies promises more in this affection than those solong recomm ended.

DIABETE S INSIPIDUS.

S y n o n y m s .Polyur ia; Hydr ur ia; Hyperur esis; Diuresis.

Def in i t ion .A constitutional disease characterized by an excessiveflow of urine of low specific gravity, and devoid of sugar and albumin,th irst, an d loss of flesh an d str ength.

Et i o l o g y .Age predisposes to diabetes insipidus, it being morefrequent during childhood and early maturity, the disease becomingmore rare after reaching the age of thirty. Heredity also plays animportant part. Weil notes twenty-three cases in a family running backfour generations. It has occurred during' convalescence of acuteinfectious diseases, and is often associated with abdominal tumors,

tuberculosis, and syphilis. The ingestion of large quantities of water orma lt liquors, is n ot infrequen tly followed by polyur ia.

Disorders of the nervous system, however, are more largely responsibleth an all oth er cau ses combined. Berna rd discovered a spot in t he floor ofthe fourth ventricle of animals, which, when irritated, is followed by



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polyuria. Tumors of the brain, blows on the head, great mentalexcitement, fright, sunstroke, apoplexy, and paralysis of the sixthnerve, have all been followed by diabetes insipidus. Epileptics notinfrequen tly ha ve this lesion.

P a t h o l o g y .No characteristic anatomical lesions are found. In somecases th e bladder is h ypertr ophied owing to const an t overdistent ion. Theureters and pelvis of the kidneys have been found dilated, due tobackward pressure due to an overdistended bladder. The kidnevs aresometimes enlarged and congested. Various lesions of the nervoussystem ha ve been foun d, but n one peculiar to polyur ia.

S y m p t o m s .Diabetes insipidus may come on gradually or developsuddenly. When due to shock or traumatism, it develops quickly,oth erwise it is insidious in its a ppear an ce. The pa tient 's att ent ion is first

attracted to the disease by the frequent calls to urinate and the largequantity voided, and that he is compelled to micturate several timesduring the night. The urine is clear, light in color, and of low specificgravity, ranging from 1,001 to 1,008, and varying in quantity fromthree to thirty quarts every twenty-four hours. Thirst is a prominentsymptom, and large quantities of water are consumed. The mouth,owing to deficient secretion of saliva, becomes dry, and the skin is dryand constricted. Usually there is but little disturbance of the digestivesystem, although persistent constipation, due to the excessive quantityof wat er voided, is a comm on feat ur e.

The only complaint made by the patient is that of aching in the loinsan d wear iness on slight exert ion. Alth ough th ere is gra dua l loss of flesh,th ere is not t he ema ciation t ha t is seen in diabetes mellitus . The sur faceand the extremities are inclined to be cool, and a subnormaltempera tu re is not u ncomm on.

The course of the disease depends to a great extent upon the primarylesion. Where due to tuberculosis or organic disease of the brain orabdomen, the genera l health fails, th e pat ient becomes mu ch ema ciated,

and the disease terminates fatally in from a few months to one or twoyears, while in idiopathic cases, the patient may live for years incomparatively good health.

D i a g n o s i s .The large quantity of urine voided, the low specificgravity and absence of sugar, enables one to recognize diabetes

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insipidus from diabetes mellitus, and the continued polyuria day afterday enables one to recognize it from polyuria due to hysteria, which isalways more or less t ra nsient.

P r o g n o s i s .When due to organic lesions of the brain or abdomen, the

prognosis is unfavorable. If idiopathic, the patient may live for yearsand enjoy comparatively good health, and a good per cent of cases willentirely recover.

T r e a t m e n t .The idiopathic form of the disease yields readily tomedicat ion, which is simple an d positive.

Belladonna .A belladonna plaster is ordered across the loins, and thespecific tincture of belladonna given internally. Ten to fifteen drops ofthe specific tincture are added to four ounces of water, and a

teaspoonful given every three hours. Where there is a feeble capillarycirculat ion, this r emedy will not disappoint in its a ction.

Rhus Aromatica.This is an excellent remedy in polyuria, but shouldbe given in fifteen to twenty drop doses, four times a day. Ergot in dropdoses every hour is also a good agent in many cases. A general tonictreatment is frequently very beneficial in bringing; about a cure. Inaddition to the tonic diuretics, hydrangia, collinsonia, hamamelis,achillea, and like remedies, the administration of the compound tonicmixture (the triple phosphate of iron, quinia, and strychnia), in half

tea spoonful doses, will give good r esu lts.

The diet should be nourishing, but easily digested, and as little fluidtaken as is consistent with good health. Moderate exercise in the openair, a nd a sponge-bat h daily, is t o be advised. An equable clima te a ssistsma ter ially in effectin g a cure.

LITHEMIA.

S y n o n y m s .Ur icacidemia; Ur icemia ; Amer ican Gout .

Def in i t ion .A condition of the blood in which there is an excess of uricacid, due to a disturbance in cellular metabolism, and characterizedclinically by various digestive, circulatory, genito-urinary, and nervousphenomena.



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Et i o l o g y .Dr. DaCosta tersely defines lithemia when he terms it acondition in which the increase of nutriment is in excess of the outputof wast e. As a result of luxu rious living, th e consumption of rich foods,and drinking freely of fermented and malt liquors, there is introduced

into the system more nitrogenous material than can be oxidized,especially since this class usually lead a sedentary life, and muscularexercise is deficient. As a result, uric acid increases, which for a timemay be eliminated by the excretory organs; but sooner or later, thekidneys, lungs, skin, and bowels are unequal to the contest, anddisturbances of the stomach, bowels, circulation, and nervous systemresult.

We may have uric acid in excess, however, in persons of modest living.In such individua ls th ere is feebleness of th e digestive appar at us, which

gives rise to the same conditions, imperfect oxidation and disturbedmetabolism.

Defect ive cap illar y circulat ion m us t be considered a cau se, th e corr ectionof which is so often attended by rapid improvement of the usualphenomena.

Heredity must not be overlooked as a predisposing factor; the patientcoming into the world handicapped by enfeeblement of every organ,lith emia nat ur ally results.

P a t h o l o g y .Osler h as well said tha t, In t he pr esent imperfect st at e ofkn owledge, it is impossible to define with an y clear ness t he pa th ology ofth e so-called u ric-acid diat hes is.

The dist ur bed met abolism , if cont inu ed for a grea t lengt h of tim e, fina llyleads to arterio-sclerosis, renal diseases, and degenerations, usuallyfibroid, of the var ious oth er t issues.

S y m p t o m s .The sympt oms due t o ur ic acid diat hesis a re legion, ma ny

of them quite vague. The principal ones are related to the digestive,nervous, and circulatory systems, although the skin and genito-urinaryorgan s sh ow more or less chara cter istic symptoms.

Gastro-Intestinal.Among the most frequent symptoms are those ofdyspepsia. The a ppetite is var iable; at times p erverted, aga in vora cious.

T h e E c l e c t i c P r a c t i c e o f M e d i c in e - P AR T V I - C o n s t i t u t i o n a l D i s e a s e s - P a g e 1 0The Southwest School of Botanical Medicine http://www.swsbm.com


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The tongue is usually coated; there is an offensive breath, acrideructations, sense of weight in the epigastrium, flatulency, nausea, andsometimes vomiting. Constipation is the rule, although diarrhea is notuncommon. Hemorrhages are usually present. A troublesome andunpleasant feature is the frequency with which stomatitis attends the

disease, usua lly of an ulcera tive cha ra cter .

Cardio-Vascular Symptoms.Palpitation is the first symptom toan nounce disturban ce of the vascular system, and a lthough a t first du eto flatulency, occurring shortly after a meal, it is not long before itdistur bs th e pat ient's rest at night. Art erial ten sion occur s lat er, followedby contraction of the arteriesarteriosclerosis.

N ervous S ym ptom s .Headache is one of the most frequent symptoms ofuric acid diathesis. It may be occipital, general, or affect but one side of

the headhemicrania. Insomnia is common, and the patient is oftenrest less an d irr itable, finally leading t o depression an d m elancholy, an dnot infrequently to suicide for relief.

Genito-Urinary Symptoms .The urine is high-colored and generally ofhigh specific gravity, 1,025 to 1,035, and, on cooling, deposits a brick-dust sediment ur ic acid. Urea, oxalat e of lime, an d th e phosphat es ar eoften present. Albumin and tube-casts are sometimes found. The acridur ine somet imes gives rise to cystitis an d ur eth ritis.

Cutaneous Symptoms.The skin becomes dry and constricted, to befollowed by severe pr ur itus an d var ious cut an eous eru ptions.

D i a g n o s i s .The frequent and persistent headache, gastricdisturbances, high-colored urine depositing a brick-dust sediment, uricacid, and rich in the prosphates, render the diagnosis comparativelyeasy. The a bsence of joint sympt oms ena bles u s t o different iate lith emiafrom gout .

P r o g n o s i s .When recognized ea rly, judicious tr eat men t should r esult

in complete recovery. Where arterio-sclerosis has developed, or wheredegener at ion of th e kidney an d liver ha s t ak en place, th e prognosis is ofcourse unfavorable.

T r e a t m e n t .Dietetic and hygienic measures are a very important, ifnot t he most importa nt, part of the t reatm ent.



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Any outdoor exercise that will bring into play the greatest number ofmuscles, should be indulged in regularly and systematically. Well-regulat ed exercise increases r espirat ion, a nd th e inta ke of oxygen h elpsma ter ially in th e bur ning of nitr ogenized tissu es. In lithem ia, oxidat ion

is defective, hence the need of systematic exercise. When the patient isfinancially able to carry out the prescription, sea-bathing is one of thebest forms of exercise, since every part of the body is brought into play.An ocean voyage is beneficial, if systema tic exercise is t ak en da ily whileon shipboard. For the stay-at-home people, golf, tennis, dumb bells,Indian clubs, rowing, brea th ing exercises, etc., should not be neglected .

Diet.As a rule the diet should consist largely of milk, fruit, andvegetables, although no diet will suit all cases. In general, red meatssh ould be excluded, a nd pork positively forbidden . Broiled or bak ed fish

may occasionally be indulged in, and the white meat of chicken. Shell-fish can usua lly be a llowed. Eggs, poached or soft boiled, ma y be servedoccasionally. Dried beans and peas contain more nitrogenous matterthan beefsteak, and should not be used often. Fruits should be freelyeat en, un less of a very acid char acter, like sour cher ries, plums, etc. Thecerea ls may be eat en freely, especially rice.

Plenty of pure or alkaline water should be taken. Londonderry lithiawater is especially to be recommended. Alcoholic, fermented, and maltliquors a re t o be prohibited.

The patient should be relieved of work and severe mental worry as faras possible.

The daily bath should be emphasized; the cold bath with brisk frictionfor the young, active, and robust. The hot bath for the feeble andelderly pat ient.

Medicinal; Hyd rangea.This agent ha s long been used in lith emia, an dwhere there is pain in the loins and irritation of the urethra and

bladder, with red sandy deposit in the urine, the agent will give goodresu lts. Hydra ngea one dra m, to water four oun ces, a t easpoonful everyone, two, or three hours should be given. The wrongs of digestion willusually be corrected by a carefully selected diet, although nux vomica,ipecac, rhus tox., hydrastis, and hydrochloric acid may be needed beforeth e norma l condition is at ta ined.



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Epigea Repens.Where there is excess of uric acid as shown by thebrick-dust deposit, backache with na usea , and ma rk ed congestion of th ekidneys, epigea will increase the flow of urine, flush out the detritus,and give marked relief. Of the specific tincture, ten to fifteen drops may

be given in an ounce of hot water, to be repeated every two or three orfour hours. An infusion usually gives better results than does thetincture.

Polymnia .Where there is enlargement of the spleen, withengorgement of the portal circulation and mesenteric glands, and butlitt le or no pain, th e tissu es full an d doughy, uvedalia one or two dram s,to water four oun ces, will give good resu lts .

Ceanothus .Where there is puffiness of the face, doughy and relaxed

skin, with pa in in t he spleen a nd liver, two to ten dr ops of cean oth us ina litt le water every two or t hr ee hour s will prove beneficial.

Carduus Marianus.When the patient is despondent bordering onmelancholy, feeble capillary circulation, enlarged spleen and liver,car duu s is th e indicat ed remedy.

Chionanthus.Engorgement of the liver with jaundice calls forchionanthus.

Grindelia Squarrosa.Where there is long-standing dyspepsia withenlargement of the spleen, and the patient sees only the dark side oflife, Professor Mundy declares that, for this patient, there is nothingequal to grindelia squ ar rosa.

Piperazin ha s been foun d of ma rk ed benefit in some cases.

Lithium Benzoate.Where th e ur ine is loaded with ph ospha tes, mu cus,an d pus, with irritat ion of th e bladder a nd u reth ra , and where th ere isten esmu s an d bur ning, benzoat e of lith ium sh ould be given.

Lithium Salicylate.If there be rheumatic pains, and the urine isloaded with the brick-dust deposit, the salicylate of lithium will be thebetter preparation.

Where t he capillar y circulat ion is feeble an d t her e is ner vous wast e, it is

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well to exam ine t he r ectu m for hem orr hoids, pockets , papillae, a nd oth erwrongs. Also sound the urethra; for when there are wrongs of theseparts, but little benefit can be expected from medicine till they areremoved.

The a lkaline miner al spr ings will be visited by ma ny with mu ch benefit..Tra vel, cha nge of clima te, a nd absen ce from bu siness a nd th e worr y oflife, will do much towards a cure. In all cases, the individual case needsespecial study, and such remedies as may be needed from time to timemust be promptly administered.

RHEUMATISM.

Def in i t ion .A constitutional disease, of unknown etiology,

cha ra cter ized by inflamm at ion of the locomotor appa ra tu s, accompa niedby great pain and tenderness, with tendency to change from one part toanothermetastasis.

Rheumatism is divided into acute, subacute, and chronic. Pseudo-rheum at ism, int o gonorrh eal and muscular .

Et i o l o g y .Many theories have been advanced from time to time toprove the specific character of the disease, each with a fair show ofpositive evidence to confirm the particular view held by the advocate.

There are three principal t heories t o which th e medical world h as beengenera lly comm itt ed, an d each of which h as h ad m an y support ers:

(1) The Chemical Theory.This for a long time was the generallyaccepted factor in the production of rheumatism. In the metabolicchanges that are constantly taking place, a perversion of the retrogrademetamorphosis occurs, giving rise to lactic acid, and possibly othercompounds, which so irritate the various tissues of the locomotorapparatus that rheumatism follows. The acid perspiration and urineseemed to confirm this view. This theory, however, is being largely

abandoned, as it is now known that some cases of rheumatism show adefect in the acids of the body, and that such patients are benefited byan acid tr eat men t. Tha t, in m an y cases of th is disease, th ere is an excessof lactic an d u ric acid, however, is well known.

(2) The N ervous T heory .It is an esta blished fact in pa th ology tha t joint



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tr oubles occur as a sequence to lesions of th e ner ves an d n erve cent ers.Charcot, Brown-Sequard, and others have called the attention of theprofession to this point. Dr. J. K. JMitchell, of Philadelphia, as early as1831, called attention to joint changes following injuries of the spinalcord, an d his son, Dr. Weir Mitchell, ha s writt en on th e sam e th ought .

(3) The Infectious Theory.The belief that the cause is microbic inorigin, t her efore infectious, is receiving a lar ge following. Various germ shave been found in the blood-serum and synovial fluid of the affectedparts, though no constant variety lias been uniformly present. Recentexperiments, in which cultures from organisms taken from rheumaticnodules reproduced polyarthritis and pericarditis in the rabbit, seemquit e significant . The fact t ha t it qu ite often occur s in epidemic form alsoten ds t o confirm th e view th at it is infectious.

P r e d i s p o s i n g C a u s e s .S ex.In young children, girls are -morefrequently affected than boys, wdiile in later life the male sex is moreliable, on a ccoun t of more frequent exposu re.

Age.The most susceptible age is from fifteen to twenty-five years,th ough n o age is exempt .

S eason.The months of February, March, and April, when there aresudden atmospheric changes, predispose to the disease.

Occupation .All occupations which are attended by exposure to theweath er, su ch as th ose of drivers, sailors, soldiers, a nd out door laborer s,predispose t o rheu ma tism, a nd th ose r equiring great exert ion, followedby rapid cooling of the body, as ironworkers, boiler-makers,foun drymen , yeast-mak ers, and brewers.

Heredity .Ther e is a h eredita ry ten dency to the disease, and it is quitecomm on t o find severa l in a fam ily rheum at ic.

Sudden Exposure.The chilling of the surface by sudden exposure in

inclement weat her is frequen tly tra ced as a causal factor in t he disease.One at ta ck of rh euma tism predisposes to fur th er at ta cks.

P a t h o l o g y .There are no characteristic changes peculiar torh eum at ism, unless we except t he lesions of th e hear t, where th is organbecomes complicat ed. Most pat ients recover without perm an ent lesions

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of the joints, notwithstanding the great amount of swelling during theprogress of the disease. During an attack, there is hyperemia of the

joints and synovial membrane, attended by swelling of the joints andligamentous tissue. There is often an increase of the synovial fluid,which may become turbid owing to the presence of fibrin flakes and

leukocytes, though pus and blood are rarely found. There is markedanemia, the red corpuscles rapidly disappearing, while the hemoglobinmay be reduced one-half and leukocytosis is quite common. In quite alarge per cent of cases t he ser ous m embra nes of th e hea rt ar e involved,giving rise to endocarditis, pericarditis, and myocarditis; the left side ismore frequently affected. The pleura and lung may also show changes,th e result of complicat ions .

ACUTE ART ICULAR RH EUMATISM.

S y n o n y m s .Inflammatory Rheumatism; Rheumatic Fever; AcuteRheumatism.

S y m p t o m s .Incubation .The period of incubation is short and notcha ra cter istic. There ma y be prodroma l sympt oms, consist ing of mala ise,stiffness, painful condition of the joints, and sore throat, especiallytonsillitis. Usually, however, the disease is ushered in with chillysensations, or even a rigor. The fever rapidly rises to 103 or 104 ;there is not only pain in the head and back, but soreness of the whole

body; the skin is hot, though often moist; the tongue is white andfurred, the bowels constipated, and the secretion from the kidneysscan ty, high-colored , an d excessively acid; the pu lse is fu ll an d frequ ent ,ra nging" from 100 to 140 beat s per m inut e.

With the advent of the fever, a joint, usually the knee, ankle, elbow, orwrist, begins to swell and becomes red, hot, and exquisitely painful. Ifthe joint is moved, the patient cries out with pain, and even thepresence of the bedclothes may cause suffering. The fever may runquite high for several days, and then gradually decline. The mind

rema ins clear sa ve when th e temper at ur e is excessively high.

Some time during the twenty-four hours, usually at night, the patientbrea ks out in a p rofuse perspira tion, which is of a sour odor, and is oftenattended by sudamina and miliary vesicles. These daily or nightlysweat s leave th e pat ient quit e prostr at ed for a time; after twent y-four or

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forty-eight hours of heat and pain in a joint, the swelling begins tosubside, the color and pain disappear, and the part, though tender,takes on a normal appearance; but, to the disgust of patient andphysician, the swelling, heat, pain, and redness occupy the attention ofits opposite fellow, or per ha ps a nother mem ber on th e sa me side. Thus it

ma y go from joint to joint, or alter na te with th e par t first affected. Theswelling var ies, usu a lly confined to th e joint , though oft en involving t hes-heat hs an d tendons.

The blood-changes are very marked, few diseases showing the markedanemia of rheumatism. The duration of the disease is variable, and noone can tell at the beginning of an attack whether it will terminate insix days or six weeks. It is one of the most painful and distressing of alldiseases. Day after da y the pa tient ma y lie with a red, puffy, an d ten der

joint, unable to move it without the greatest pain, and, to add to his

discomfort, a profuse, sour sweat occurs, the odor of which adds to hismisery. As the days pass, the sweat loses its acidity, and may evenbecome alkaline.

The heart may early feel the force of the infection, and the murmur inthe apex region is the note of warning. This organ should be examineddaily th at we may be prepar ed with tr eat men t t o modify the force of th edisease.

In subacute rheum atism th ere is usua lly but litt le fever; the pulse ma y

be increased five or ten beats per minute, and be more full andbounding or hard, the skin harsh and dry, the tongue coated, theappetite somewhat impaired, bowels constipated, and the urine scantyand deeper colored. These symptoms follow instead of preceding the localaffection.

One or more parts may be affected, the larger joints suffering mostfrequently, the smaller ones next, and the aponeurotic expansions andmuscles least. When a part is attacked, it commences to swell, andbecomes hot and painful, though in many cases it is not reddened. The

pain, as in the preceding cases, is gnawing, tearing, tensive, andcontusive, or lancinating, though usually not so severe as in the acuteform . It does not cha nge its position so frequen tly, but still a m eta sta sisis not u ncomm on. It is full as st ubborn as th e more acut e ma lady.

C o m p l i c a t i o n s .The most serious and really the only complications

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that need be considered are those affecting the heart, occurring mostfrequently in the acute form, though found both in the subacute andthe chronic. It occurs far more frequently in the young than in thosepast middle life. Dr. Peacock foun d th at th irty-th ree an d a t hird per centoccurred under twenty-one years of age, and only sixteen and six-

ten th s per cent a fter fort y year s of age.

The left heart is nearly always the seat of the lesion, for the samereason that the larger joints are almost invariably the seat of the localtr ouble; viz., grea ter fun ctional a ctivity.

Formerly it was supposed that the cardiac lesion was the result of ametastasis from some other part, but this idea has given way to themore rational one of similarity of structure to that of the joints; viz.,fibrous and serous, and though the structure of. the right heart is the

same as that of the left, there is much less functional activity of theright. Its walls are thinner, and there is less tendinous material in itsvalves. The work is not so severe an d th e str ain n ot so grea t. It h as beendetermined that the left heart bears three times the strain of the right;hence the greater functional activity and greater susceptibility toinflammation.

Endocarditis.This is the most frequent as well as the most seriouscomplication, for it involves the mitral segments, and, though rarelydangerous, it is apt to set in motion changes which result in chronic

valvular tr oubles, th at influence the h ear t's a ction t hr oughout life. Witheach at ta ck of rh eum at ism, the liability to th is complicat ion increases.

The symptoms are rather vague, and many times are overlooked. Anincreased frequency of pulse, and an increased temperature without anincrease of th e local joint affection, should ar ouse suspicion a nd tu rn ouratt ention to the heart .

Pericarditis .This is rarely found as a primary disease, but followsvarious infectious lesions, and, in from sixty to eighty per cent, can be

traced to rheumatism, and though one of the most common ofcomplicat ions, like en docar ditis, is often overlooked durin g life, an d onlyrevealed post-mortem while searching for other lesions. It may occurwith en docardit is or independent ly of th at affection.

Myocarditis.This is n ot so comm on a lesion, a nd when it does occur , is



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preceded by t he above-men tioned complicat ions .

D i a g n o s i s . We have but little trouble in making the diagnosis ofrheumatism, the swelling, heat, and peculiar character of the painbeing genera lly su fficient . It is tr ue t ha t, in cases of disease of th e bones

or of the cartilages or synovial membrane of a joint, it is sometimesalmost imp ossible; yet th e cha ra cter of the pain, t he genera l condition ofth e system , and t he fact th at rh eum at ism is rar ely confined to one point,will frequ ent ly enable us t o decide.

Rheum at ism of th e back, or lumba go, is sometimes m ista ken for diseaseof the kidney or spinal cord; but if we recollect that, in disease of thekidney, we will usually have retraction and pain in the testicle, changein the character of the urine secreted, and more or less constitutionaldisturbance peculiar to suppression of the urine, and that in disease of

the spinal cord to this extent, we would have disturbance of all thener ves given off below, we will not r eadily ma ke t he m ista ke.

Neuralgia is very frequently confounded with rheumatism, and it issometimes almost impossible to distinguish them; but in a majority ofcases, the pain, being exquisitely sharp, tearing or lancinating, and inth e cour se of a ner ve, will ena ble us to see tha t it is neur algia.

Gout usu ally occur s in t he sm aller joints, pr efera bly th e great toe; th enth e age, ha bits, an d h istory of onset will help us in r ecognizing th e one

from the other. We can distinguish rheumatism from arthritis, by thehistory of pyemia, and the inflammation terminating in suppuration,an d th e more or less dest ru ction of th e joint.

P r o g n o s i s .This is nearly always favorable, for though the heartcomplications are frequent, they rarely cause death. Our prognosis,therefore, is favorable as to life, but uncertain as to length of time thedisease will run; for of all diseases that affect the human race,rh eum at ism is th e most u ncerta in. Some very severe form s will yield ineight or ten days, while oth ers s eemingly not so severe will ru n eight or

ten weeks.

T r e a t m e n t .Specific medicines yield better results than the so-calledrheumatic combinations, and if a careful selection is made according tospecific conditions, the majority of cases will yield more speedily thanun der th e old regime.



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The patient should be placed between blankets, and wear a flannelnight-dress, with the sleeves open from shoulder to wrist, that we mayrea dily get a t elbow an d wrist. The pa tient is less apt to tak e cold afterprofuse sweat ing if protected by flan nel.

Locally, th e pa rt should be wra pt in cott on, or wha t is better , ra w wool.Where the pain is great, chloroform liniment is often of much benefit. Afavorite local remedy is camphor and turpentine, of each one ounce, andalcohol t wo ounces.

If seen early, the old alcohol sweat is of great benefit. Have the patientdisrobed an d placed on a wooden bott om cha ir, with a blanket coveringhim from the neck to the floor. Place four ounces of alcohol in a cup,which should be set in a pan of water, and this placed under the chair;

have the patient's feet in a deep bucket of hot water; light the alcohol,and the patient will soon reach the sweating stage. Allow the patient todrink freely of cold water; the perspiration will soon start from everypore, and after ten or twenty minutes of this treatment, place thepatient in bed with hot-water bottles to feet, and in a few minutes thepatient falls into a quiet sleep. Where this is carefully followed, I knowof no tr eat men t which' will so successfully cut short th e disease.

Internally, for the full, strong pulse, I use veratrum in full doses, sayth irty or fort y drops to half a glass of wat er, to which I add sulpha te of

morphia, a half grain. This overcomes the nausea occasioned by theveratrum, and also assists in relieving pain. To the sedative may beadded bryonia, five to ten drops, especially where the pain islancinat ing in cha ra cter.

Where there is great muscular soreness, use macrotys, and give inrather large doses, say one or two drams to half a glass of water. Dr.Webster speaks very highly of Rhamnus californica in stubborn cases,an d from wh at I ha ve seen of its effect s, I like its a ction very mu ch .,

Where the parts are swollen and there is edema, apocynum is theremedy, and if there arise heart complications, it is the remedy parexcellence. I know of no other remedy which can equal it under theseconditions; the decoction gives the best results.

Where the tongue is broad and full, and there is puffiness under the

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eyes, potassium acetate will give good results. A good combination issalicylic acid one dram, potassium acetate four drams, water fourounces; a teaspoonful every four hours, the patient drinking freely ofwater after each dose.

Where the t ongue ha s a past y, dirty fur upon it, a sat ura ted solution ofsodium sulph ite gives good r esults; but if th e t ongue be white, but clean,sodium salicytat e in five-grain doses every t hr ee h our s will replace t hesulphite.

Often we have the red tongue and mucous membrane; here muriaticacid takes the place of the alkali; lemon-juice is also grateful andbeneficial.

Where the pain is unbearable, a hypodermic of morphia may be

necessary to give relief, but this should be avoided, except in extremecases. Blisters should be discar ded, for while th ey ma y give tempora ryrelief, the after effects are so painful that the good is counterbalancedby th e sufferin g.

The diet should be light, milk in some form being the best, cow's milk,malted milk, broth, whey, or koumiss. Where the patient can not takemilk, broths may be substituted. Avoid meats and starchy and sweetfoods t ill all fever disappea rs an d secretions ar e fully established.

The tr eat men t for t he suba cut e form will be very much th e sam e, minu sth e sedat ives, and even her e th ere ma y be indicat ions for t he sm all dose.Gent le ma ssa ge will often afford' m uch relief.

CHR ONIC ARTICULAR RH EUMATISM.

S y n o n y m .Chronic Rheuma tism.

Def in i t ion .A chronic articular disease of the joints, developing

insidiously, or following the acute or subacute forms. It usually affectstwo or more joints, a nd is most likely dependent on th e sa me conditionswhich give rise to the acut e form s.

Et i o l o g y .Ther e are severa l predisposing cau ses, such as,

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Age.This is a lesion a lmost invar iably occurr ing after middle life.

S ex.Fema les ar e more prone to the disease t ha n m ales.

Environments .One's surroundings materially predispose to this

condition. Where the dwelling is low and damp, the rooms dark andpoorly ventilated, a nd where poverty n ecessitat es poor an d illy prepa redfood and insufficient clothing, exposing the patient to all kinds ofweath er, ther e is a t endency to the disease.

Heredity .Heredity may also operate in favor of bringing aboutcond itions favora ble for its development . In some cases it ha s it s originin imperfect digestion and assimilation, which we would readily accountfor, on the theory that an increase of lactic acid was the cause of thedisease.

In others it seems to have arisen from, and is dependent on, deficientaction of the excretory organs, and possibly on some changes in theprocess of ret rogra de m eta morphosis, by which th e broken-down tissu esare converted into material fit for excretion; and in others, upon somederangement of innervation. There is but little doubt that the samecauses which give rise to the acute and subacute forms are actively atwork in pr oducing th is form of th e disease.

P a t h o l o g y . When the joints have been the seat of the disease, we

find th em var iously altered. In some cases th ere seems t o be noth ing butan increase of the synovia; in others the synovial membrane isthickened, especially the false ligaments; in some cases roughened,covered with shr eds of false m embra ne, or adh erent , coagula ble lymph,and the synovia more or less viscid, shreddy, and in some casespurulent. The articular cartilages are sometimes softened, at otherseroded, and in some cases completely destroyed. The articularextremities of the bones are not infrequently enlarged, and theligaments, tendons, and muscles contracted or relaxed. When affectingother parts, if of long duration, it may so change their structure as to

leave litt le resemblance to their origina l condit ion.

S y m p t o m s .Dr. Scudder so clearly describes the disease that I willquote him in full: As r egards th e genera l hea lth of the pa tient , we findthat it varies greatly in different cases. In some there is a manifestderangement of the stomach, various unpleasant sensations, as of



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fullness, pain, acidity, flatulence, etc., occurring after a meal, andshowing t ha t digestion is not well perform ed. In su ch cases we find t hepatient reduced in flesh and strength, and exhibiting evidence ofmarked general cachexia. In others, the secretions are manifestly atfau lt, the k idneys acting poorly, or t he sk in is ha rsh an d dry, or r elaxed

and flabby, and the bowels irregular. It is true that we find cases ofchronic rheumatism in which we can not detect the slightest lesion,except t he local r heu ma tic disease; wha t loss of flesh an d st ren gth th ereis being a tt ribut able to the cont inued su ffering an d loss of rest resu ltingfrom it; met as ta sis occur s in th e chr onic as well as th e acute disease.

It most frequent ly affects th e a rt iculat ions, t hey being swollen, t ender,an d pa inful; one or more ma y be affected a t t he sa me t ime, usua lly notmore than two, and the amount of swelling, discoloration, and painvaries in different cases; sometimes the tenderness and pain are

exquisite; at others it is not very marked. The articulation is in somecases ent irely useless, motion or pressu re giving r ise to severe su fferin g;at others, though lame, it may still be used. In some cases it takes theform of synovial dropsy, it being very evident that the enlargement isalmost entirely dependent upon effusion into the joint; at others, theenlargement seems t o be dependent upon ma terial with in th e synovialmem bra ne, but it is not nea rly so mobile as before. In other cases t her eis marked enlargement of the articular extremities, or a dull, heavy,gnawing pain, with great tenderness, when the bones are placed so asto give rise to pressur e on t heir extr emities. In oth er cases th e deposit is

undoubtedly outside, involving ligaments, tendons, and muscles thatpass between the two bones, causing relaxation in some cases,cont ra ction in other s, th us giving r ise to deform ity. In some cases th is isvery marked, bones being dislocated, or tendons so shortened as toproduce unnatural flexion or extension, or to change the position of thebones, as in t he case of th e kn ee-joint, t he a rt iculat ion of the t ibia beingso cha nged as to produce kn ock-kn ee, an d t ur n th e toes out war d ; or, inth e case of lum bago, or r heu ma tism of th e dorsa l or lu mba r port ions ofthe spine, giving rise to spinal curvature and other distortions. If itattacks a group of muscles, we may find them gradually shortening,

un til a limb is r endered ent irely useless, as in th e case of cont ra ction ofthe hamstring muscles, and flexion of the knee, and finally terminatingin th e almost ent ire cha nge of th e muscular st ru ctu re.

D i a g n o s i s .This is usually not difficult, the history of the casematerially assisting in determining the disease. In gout, the pain is

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confined t o sma ller joints, a nd t he pa in is not a ggra vated by a cha nge ofweather.

P r o g n o s i s .This is not favorable so far as effecting a cure isconcerned; for u nless t he disea se is seen in its incipiency but litt le can be

expected in t he wa y of a r adical cur e. However, medication mit igates t hesuffering and improves the general health. Very few die from thedisease.

T r e a t m e n t .Where the patient has the means, a change of climatewill often prove of great benefit. A visit to Southern France or Italy, orour own Southern California, or the dry, warm atmosphere of Arizona,often works changes that can be accomplished in no other way. Asojour n a t H ot Spr ings, Ark an sas ; Mart insville, Indian a, or t he var iousmineral springs to be found in the various States, will do more for a

pat ient in a few weeks or m ont hs t ha n year s of ordina ry medicat ion.

Of the various anti-rheumatics, a few deserve especial mention.Apocynu m, in th e form of a decoct ion, h as been one of th e best rem ediesI ha ve ever used. Where th ere is edema , slight or aggra vated, it ha sfew, if an y, equa ls. Comm ence with ten -drop doses, gradu ally increa singthe dose to a teaspoonful if the stomach will retain it. The one seriousobjection to the remedy is its intense bitter quality and the sense ofnausea it produces, many patients being unable to retain it. Whereth ere is hea rt complicat ion, it is one of th e best r emedies at our disposa l.

The alkaline diuretics, potassium acetate, citrate, or nitrate, will befound useful where we desire to stimulate metabolic changes, and thusfit t he poison t o be bett er elimina ted by way of th e kidneys. Dr. Websterspeaks highly of rhamnus californica and grindelia squarrosa; of theother many remedies which may be used, I will only add, when theconditions pr esent call for t heir use, of cour se adm inister t hem . Man ycases will need oth er rem edies th an th e ant i-rh euma tics.

Wrongs of the stomach need to be corrected, for a rheumatic dyspeptic

will not impr ove so long a s digestion is impa ired. Wrongs of th e kidn eysneed to be corrected, and so do those of any other organs. Many times,rheumatism continues owing to nerve impingement affecting thecapillary circulation, and a removal of the source of irritation results ina rapid recovery.



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One of th e ha ppiest cur es I ever effected was accomplished by corr ectin ga diseased rectum. The patient had been medicated for months, hadspent several weeks at Clifton Springs, N. Y., but had failed to receivebenefit; the removal of hemorrhoids and papillae with a thoroughdilating of the rectum, soon effected a cure. Where remedies fail to give

benefit, examine th e rectu m, ur ethr a, an d ut erus. If th ere ar e sources ofirritation in these organs, no improvement will follow till they arecorrected.

As to local applications, the old irritating plaster accomplished wondersin the hands of the earlier Eclectics. This rather harsh treatment,however, has fallen into disuse and the various stimulating linimentshave taken its place, although I still believe that the old plasteraccomplished bett er r esults.

The patient should wear flannels at all seasons of the year, and avoiddamp, low places. The diet should be largely of vegetables, fruits, andfarinaceous foods; he should turn vegetarian, though fish and bivalvesmay be used in season; Londonderry and Buffalo Lithia waters will dosome good. Electricity will give relief in some cases, and will be morefrequen tly used wh en we lear n better th e conditions calling for its u se.

MUSCULAR R HE UMATISM.

S y n o n y m .Myalgia.

Def in i t ion .A painful a ffection of th e mu scles an d t heir a tt achmen ts,the fasciae and periosteum. There is most likely some constitutionalderangement, and the myalgia is but a local echo of the generalcondition. The local affection has taken special names according to theseat of the pain; thus torticollis, or wry-neck; lumbago, pain in thelumbar region; pleurodynia, pain in pleura; mastalgia, pain in thebreast , etc.

Et i o l o g y .The predisposing causes are various, the most commonarising from sudden cooling after severe exertion, or by exposure to adraft of air, as sitting by an open window, by getting chilled byexposur e in in clement weat her . A severe str ain or twist ma y be followedby a crick in t he ba ck, or lu mba go.

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The rheumatic or gouty diseases also predispose to the trouble. Theprimary cause is unknown, and some contend that it is neuralgic incharacter, affecting the sensory nerves of the muscles, while somecont end t ha t it is infectious .

P a t h o l o g y .The pa th ology is n ot const an t. In some cases t her e is litt leif any muscular change, while in others there is slight granulardegeneration of muscular fibril, or, again, atrophy of the musculartissue. Nodes are sometimes found. There may be inflammation of thesheaths or periosteum, and in some cases thickening and degenerationof th e neur ilemm a of th e nerves supplying th e par t.

S y m p t o m s .These depend somewhat upon the form or location ofpain. It is nea rly always local in its effect, t her e ra rely being a ny fever;usually the pain is intermittent, any motion or sudden jar causing

excruciating pain; at times the pain is constant. Deep, firm pressureaffords some relief. The attack comes on suddenly, and often assuddenly takes its departure; it may last for a few hours, or persist forseveral days.

Lumbago.In this form the muscles of the loins are the ones affected,an d it more often occur s am ong laboring men . The a tt ack is sudden, an dthe patient imagines that he has strained his back; or he may be in astooping position, and on attempting to straighten up is seized with asha rp, lan cinating pain t ha t m ay bring him t o his knees. When sitting,

the patient gets up with great difficulty and much pain; if lying down,he is unable to rise or turn over; in fact, any motion on the part of thepat ient causes him t o cry out with pain.

Torticollis, or S tiff N eck.In this form the pain is confined to themu scles of th e neck, an d an y motion of th e hea d cau ses int ense pa in; asa consequence, when the patient wants to turn his head, he turns thewhole body. This form occurs more frequently in the voung. Generallythe patient's head is inclined to the affected side, thus relaxing themu scles an d securing r elief.

Pleurodynia.The pain is in the intercostal muscles, and is oftenreferred to as a stitch in th e side; th e pain is sha rp a nd lan cinating, andintense on full inspiration or on coughing. This is often called pleurisy,but th e difference is readily distingu ished when we note th e absen ce offever a nd t he advent itious sound on ausculta tion.



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Abdominal Rheumatism.There are a number of other forms thoughless comm on, wh ich will be recognized by th e locat ion of the pa in; th us ,cepha lodynia , pain in muscles of th e sca lp; ma s-todynia , pain in musclesof chest ; scapu lodynia, pain in scapular region; abdomina l rh eum at ism,

pain affecting t he abdominal r egion.

D i a g n o s i s .This is usu ally quite readily ma de. In th e various form sconsidered, the sharp pain, the absence of fever, increased suffering ofth e par t a ffected, will distinguish t he lesion a s mu scular rh euma tism.

P r o g n o s i s .This is favorable, rarely, if ever, a patient dying, unlessth ere be severe heart complicat ion. If seen ear ly, th e painful conditionsar e usu ally relieved in a few hours, or at most a few days. If neglected,however, it ma y assu me a chr onic form .

T r e a t m e n t .One of the best agents for this form is macrotys given inquit e lar ge doses; of th e specific tin ctur e one d ra in, to wat er four oun ces,a tea spoonful every h our ; or if th e decoction is u sed, give in t easpoonfuldoses every hour . Bryonia will combine n icely in pleur odynia .

In all these cases, dry heat is one of the best local applications. Wherethe pain is excruciating, a few drops of chloroform on flannel, heldaga inst th e pain ful pa rt , gives quick relief. For st iff neck, galvan ism willsomet imes give great relief. For lum bago, I kn ow of no bett er t rea tm ent

than dry cupping; I have seen patients straighten up and walk offcomfortably, after removing one or two large cups from the lumbarregions.

In those acute cases where the pain fs unbearable, a hypodermicinjection of morphia, one-fourth grain, gives speedy relief. This,however, should only be given in extreme cases. After an attack, anywrong of the general hea'lth should be corrected, and thus prevent aspeedy retu rn of th is painful th ough not da ngerous a ffection.

GONORRHE AL ARTHRITIS .

S y n o n y m .Gonorrheal Rheumatism.

Def in i t ion .A specific sept ic a rt hr itis, or syn ovitis, due t o th e poison of

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Eclectic Medicine Part 6

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