TREATMENT.—The indications are threefold: (a) relief of pain; (b) physiological rest for the affected muscles; (c) restoration of the balance between the nutrition of the muscle and the work it has to do.
(a) Relief of pain is often secured by rest in a posture that permits the complete relaxation of the muscles involved. In acute cases due to overwork pure and simple, and where complete rest is attainable, little other treatment is required. In the course of a few hours or days the function of the muscles is fully restored and their contractions are performed without pain. Where, however, complete muscular relaxation is impracticable or fails to afford relief, anodynes are necessary. Morphine hypodermically is very useful, but this altogether independently of any local action. Continuous dry or moist heat by means of flannels, flaxseed poultices, spongio-piline, etc. may be applied. Various anodyne lotions are useful. Liniments containing aconite, belladonna, chloroform, or chloral also afford relief. The compound belladonna liniment of the British Pharmacopoeia is especially to be recommended. So also are plasters of belladonna, conium, and mustard. Galvanism occasionally gives prompt relief. The same statement may be made of the use of static electricity. The pain sometimes disappears under gentle and long-continued massage.
(b) Rest is usually enforced by the intensity of the pain attending movement. In severe cases the bed is a necessity. In affections of the respiratory muscles, as pleurodynia, firm support of the side, by means of overlapping strips of plaster drawn from the spine downward and forward in the direction of the ribs to the median line in front, is sometimes necessary and always comfortable.
(c) The balance of nutrition is restored by rest. Local means to further this end are such as relieve pain—heat, anodyne and stimulating frictions, massage, and galvanism. The parts must be protected from sudden changes in temperature by extra thicknesses of flannel or sheets of wool or cotton batting—if necessary covered with a piece of oiled silk or fine gum-cloth. In old cases prolonged massage with passive movements, shampooing, and the slowly interrupted galvanic current, alternating with rapid faradic currents, are followed by good results.
As a constitutional measure a Dover's powder at night, followed by mild purgation in the morning, is often indicated. Purgation is especially called for in plethoric or gouty persons, in whom also Turkish or vapor baths are of great service, while poorly-nourished, anæmic subjects demand quinine, iron, lime, and cod-liver oil. If the attack linger, full doses of ammonium chloride, and in old cases potassium iodide in moderate doses well diluted and long continued, are advocated; and in stubborn cases Anstie recommends deep acupuncture of the muscle near its tendinous attachment. In cases marked by a tendency to spastic rigidity the repeated hypodermic injection of atropine may often be relied upon as the speediest means of cure.
Where the general nutrition is poor the local trouble is apt to be obstinate, and often yields only to measures that restore the general health.
PROGRESSIVE MUSCULAR ATROPHY.1
BY JAMES TYSON, A.M., M.D.