§ 163. D. Lumbago rheumatica.

This is a rheumatic affection of the lumbales muscles, from the posterior portion of the vertebral column to the crest of the ilium, generally on one side only. The pain is generally tearing, drawing, seldom sticking, appearing periodically and frequently shifting to some other place. The pain is very much aggravated by motion, so that the patients keep their backs quite stiff. There is no swelling or rednesss, but a darting pain is experienced along the muscle on touching it. There is very little fever. The disease is liable to be confounded with psoitis, nephritis or an affection of the lumbar nerves. In the latter affection, however, violent pains are present, which set in like electric shocks; they follow the track of the nerves, and are not aggravated by motion or contact. In nephritis, the pain is rather deep-seated, dull, aching, and following the course of the ureter; the urine is dark, bloody, purulent, attended with strangury, dysury and disturbance of the digestive functions. In psoitis, the pain is located in 'the region of the insertion of the psoas-muscles, the transverse processes and bodies of the lumbar vertebrae; it follows the course of the muscle beyond Poupart's ligament towards the thighs, swelling soon sets in under Poupart's ligament, and the characteristic pain in the knee and pain on moving the thigh is felt.

§ 164. Aconite is seldom required in this affection. The chief remedies are: Bryonia, Colchicum, China, Pulsat., Arn., Rhodod., Nux vom., Sulph., Ledum. China corresponds particularly to violent tearing, sticking, drawing pains, which are increased by the least motion, or to bruised pains in the small of the back, with occasional painful jerks in the region of the os sacrum; it corresponds likewise to the dragging pains in the small of the back as from a load or as from long stooping, with nervousness and general debility. Nux vom. is useful in violent, painful jerks, and jerklike, dull sticking; in pains in the small of the back, which appear periodically and extend to the shoulder and down to the sexual organs, occasioning even a lameness and stiffness of the lower limbs. Rhodod. has been frequently found useful in violent pains in the small of the back preceded by a tearing pain in the arm and nape of the neck; the pain was worse during rest and in bed, and, in the evening, it sometimes extended as far as the abdominal ring, accompanied with drawing, pressing pains in the testicles.

§ 165. Sometimes, on stooping, a most excruciating pain is suddenly felt in the small of the back, so that the trunk can only be raised with the greatest difficulty, and the least motion in the small of the back is impossible. The pain lasts from two to eight days, and is unaccompanied by fever, or any other morbid symptoms. The pain arises probably from the stretching or tearing of a few muscular fibres, or a muscular sheath. Arnica, Nux v., Rhus t., Bryon., Sulphur, Ledum, are the principal remedies. I have frequently cured this pain with Nux and Sulphur alternately, in one or two days.

Rheumatic lumbago sometimes affects the cervical or abdominal muscles. There is tearing pain in one or both sides of the neck, which can scarcely be turned or moved; sometimes the inner parts are affected, occasioning a morbid condition like angina. Belladonna and Li/cop. are the best remedies. If the abdominal muscles be the seat of the disease, the tearing pain follows the course of the muscular fibres, in either the recti or oblique muscles, and is aggravated by motion. There is no distention, no sensitiveness, no nausea or vomiting, no fever, as in peritonitis and enteritis, although this former disease may develop itself out of lumbago, by the rheumatism invading the peritoneum. Arnica is generally a specific for this kind of pain.

If the rheumatism should affect the articulations of the vertebral column, rendering motion impossible; or if symptoms of tetanus or trismus should set in in consequence of the articulation of the temporal bone and maxilla being affected by the rheumatism, Bellad., Nux vom., Causticum, Cocculus, Colchicum, should be used.