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714 RHEUMATISM AN INTERNATIONAL CONGRESS IN SWEDEN AT the invitation of the Swedish Committee on Rheumatism, whose secretary is Dr. G. KAHLMETER, the fifth biennial congress of the International League against Rheumatism was held in Lund and Stockholm from Sept. 3rd to 8th. Members from many countries met at Lund under the presidency of Prof. SvEN INGVAR, and a large proportion went on to Stockholm where the congress concluded in the presence of Prince CHARLES OF SWEDEN, its honorary president. ALLERGY AND ARTHRITIS In a discussion on allergy in rheumatic diseases some of the speakers, including Dr. JOHN FREEMAN (London) and Prof. G. MOTJRIOUAND (Lyons), main- tained that neither rheumatic fever nor rheumatism can be attributed to allergy, though allergic condi- tions can be observed in infective cases. Others, however, regarded allergy as definitely causal. Thus Prof. F. KLINGE (Munster) found more and more reason to suppose that rheumatism depends upon damage to mesenchymatous tissues by allergic reaction to various kinds of antigens. Prof. RossLF (Berlin) held that the morphological equivalents of allergy (anaphylaxis) vary with the tissues and organs affected ; in the smooth muscle-fibre there was cramp, in the mesenchyma there was chronic inflammation with local proliferation. In the specific infections also there were granulomata with cutaneous and focal reactions. Non-specific focal and diffuse inflammations likewise played a part in allergic disease-the nature of the inflammation being the same whatever the allergen. Their biological function was to localise dangerous toxins. Prof. V. TAT.ALAaFF (Moscow) said that an allergic state preceded the onset of the disease, which was thus " secondary," a previous illness commonly producing sensitisation. Rheumatic fever could be regarded as of allergic-infective origin, infection being the exciting cause. Dr. ANTON Flscx3ER (Budapest) thought that the allergic nature of rheumatism was not proven ; but both the course of rheumatic fever and the connexion between chronic rheumatism and weather reminded one of allergic conditions. Dr. F. GUDZENT (Berlin) pointed out that both rheumatism and gout occurred in families liable to allergic diseases. Of his rheumatic and gouty patients, 35 per cent. reacted to animal albumins and 55 per cent. to vegetable albumins. All rheumatic conditions were, he believed, due to an inherited or acquired hyperergic reaction to foreign albumins. Dr. CAUTERMAN (Antwerp) supported the theory of an allergic condition in chronic non-infective rheumatism. RADIOGRAPHY.—MYALGIA Dr. BASTOS ANSART (Madrid) and others spoke of common errors of diagnosis in the radiography of arthritis and the wide divergence observed between the X ray appearance and the functional state of the joints. Prof. ROCHLIN (Leningrad) showed that a great variety of setiological factors, including normal degenerative processes, might produce similar X ray appearances. Drs. WEISSENBACH and FRANÇON (France) found that photographs in series were not only good documentary records but assisted the differentiation of arthritis. Dr. G. vAN DAM (Amsterdam) exhibited some interesting pictures of ’’’ infective arthritis " in the hand, showing in early cases a. transverse contraction, also a destruction of bone under the cartilage of the heads of the metacarpal bones. Prof. SvEN INGVAR (Lund) regards sciatica not as a neuritis but as a myalgia due to trauma and associated with circulatory disturbance. It has often been recognised in sciatica that the affected limb is colder than its fellow (by 1-2° C. or more), and Prof. Ingvar has found that normal temperatures can usually be restored by artificial hypersemia as well as by vasodilator drugs such as caffeine. Pyrifer (coli vaccine) has also proved helpful in obstinate cases by raising the general body temperature, as in severe cases of neuralgia. Physical treatment is usually vasodilator. Prof. JULIUS ROTHER (Berlin) called attention to the importance in many myalgias of disturbances in blood circulation and body heat, brought about by repeated exposure to cold. This led in time to a general defect in heat regulation. Other cases are mainly caused by mechanical and static abnormalities. The choice of pathological theory had a considerable bearing upon treatment. Dr. C. VOLTA (Barcelona), like others, took similar views. Myalgia, he said, signified clinically pain, muscular contraction, and palpable infiltrations and nodules, and was brought about by disturbances of blood circulation in the muscles. Toxic and bacterial poisons might be contributory causes. Dr. ERNST FREUND (Vienna) spoke of the many factors of causation-in addition to possible infection, metabolic abnormalities, fatigue, strain, trauma, and chill- producing a variety of tissue changes. Dr. J. B. BURT (Bath) called attention to the special liabilities of muscles acting in a confined space. For example, the conditions sometimes diagnosed as neuritis in the arm are, he believes, due to myalgia or myositis in the supra- or infra-spinalis muscles, which are eon- fined between the scapula and a dense fascia. The same trouble in the gluteus medius might set up pain in the leg. The inflamed muscle pressed upon the subjacent nerve. In such cases the affected muscle would be found to be tender and should be treated with heat and massage. " ORTHOPEDIC " TREATMENT OF ARTHRITIS The adjective " orthopaedic " is now made to cover many simple preventive measures in the treatment of arthritis. The discussions revealed uncertainty about the proper balance between immobility and exercise, and emphasis was laid on the danger that routine treatment may aggravate the disease, especially in the inflammatory phase. Many speakers, like Dr. WEISSENBACH and Prof. P. MATHIEU (Paris) strongly urged the study of posture in the earliest stages of the disease and the systematic prevention of deformity by means of plaster bandages and splints. Dr. LORING T. SWAIM (Boston, U.S.A.) had developed an effective and ingenious system at the Brigham Hospital in Boston. The methods were demonstrated in a series of pictures. As a rule complete immobilisation of an arthritic joint or joints is practised at the earliest possible stage. This overcomes the injurious flexor spasm and gives the inflammation a chance of subsiding. " Deformities are not allowed to occur." Later, when it is safe to release the joints during the daytime they are splinted every night, to prevent the risk of spastic contraction during sleep. The same applies to arthritic flexion of the spine, the supports being used until active disease has subsided. During convalescence braces and exercises of various kinds restore the joint functions and keep the posture normal.
