ACUTE MYOSITIS - DISEASES OF THE MUSCLES.
We may describe here two forms—acute simple and acute infec tious myositis. The latter again may be divided into two varieties: one, studied by Bruuon, which is accompanied most frequently by suppuration; the other, studied by Hepp, Marchand, Larger (These de Paris, 1890), and very recently by Gouget (Pi.esse jiedicale, Sep tember 1st, 1894) in which there is never any formation of pus.
Acute Simple 31yositis. —This affection declares itself after a few indistinct prodromal symptoms. Following an exposure to cold or after excessive fatigue, the patient is taken with malaise and lassi tude, and soon pains more or less severe are felt in the affected mus cles. These pains, which are laminating in character, are increased by pressure and impede voluntary movement. The position of the affected limb is often modified by the efforts of the patient to ap proximate as much as possible the points of origin and insertion of the inflamed muscle. As a consequence of the inflammation there may also be an actual shortening of the muscular fibres.
When the superficial muscles are affected the overlying tissues are changed iu color, the skin being more or less intensely red and occasionally ecchymosed. We may also note cedema and swelling of the neighboring parts. When the muscles are sufficiently near to the surface of the body to be accessible to inspection and palpation, they may be seen stretched like tense cords under the skin, and they give to the finger an impression as of a hard body—a wooden sen sation.
In mild cases it is doubtful if any general symptoms will be pres ent, and if they are they will be found to be of slight importance. They consist in a slight rise in temperature, a little falling off of the appetite; but by the end of from two to fourteen days they will have all disappeared and the patient will be restored to his usual health. The pains will have also disappeared, and nothing will remain unless possibly a slight sensation of fatigue in the muscles that were the seat of inflammation. But the disease does not always have such a favorable and speedy termination.
More pronounced general symptoms may be present—fever, usu ally of moderate intensity, insomnia, and some gastric disturbance. The inflammation of the muscles lasts for from twenty-eight to thirty days, but then ends in resolution without suppuration. It may be, however, that the pains show no tendency to diminish; the general symptoms, without becoming really grave, show no amelioration; and in time the myositis passes into the suppurative form. Pus forms and collects, fluctuation appears, and a true abscess results. Such are the symptoms of simple acute myositis.
Acute Primary Infectious Hyositis.—The course of this form of the disease is much less favorable than that of the variety just described. As was mentioned above, there are two forms of this variety of in flammation, of equal gravity indeed, but differing as regards the ten dency to the formation of pus. In order to distinguish these two forms, I would call the first one, that in which there is a tendency to the formation of pus, "acute primary infectious myositis, properly so called," and the other form, that which runs its course without suppuration, "acute primary infectious polymyositis." Acute Primary Infectious Myositis, Properly so Called.—This affection may begin in one of several ways. Sometimes, and most commonly, it is the general symptoms which first attract attention; at other times, and less frequently, the disease appears as an acute simple myositis. In the latter case the patient complains first of violent pains in the muscles, then the general symptoms become more and more severe and we find ourselves in the presence of an in fectious myositis. In the ordinary variety the patient is suddenly taken, after some physical overstrain, with a chill or a succession of chills followed immediately by a fever of considerable intensity, reaching as high as 104° F. There is a general lassitude; the appe tite is lost; and sometimes there is more or less stupor. While these general symptoms alone are present there may be some uncer tainty iu diagnosis, but this for a short time only, as soon the mus cular pains begin to declare themselves and point clearly to the nature of the trouble. These pains, which are of varying degrees of severity, tend to localize themselves in certain regions, principally in the muscles which have been overstrained. the local disorder has become established, palpation, which may be exquisitely painful, reveals a wooden hardness along the course of the affected muscle, if the latter be superficially located. The skin, which presented a nor mal appearance at the beginning of the malady, is now covered with irregular patches of red discoloration. There is swelling over the region of the diseased muscles, and there may even be cedema of con siderable extent. Finally the finger may detect a certain puffiness, or even fluctuation, if pus has formed. In these conditions the case is comparatively simple. Sometimes, especially when the disease attacks the deeper muscles, there are few or no local symptoms, and even pain may be absent. We may well understand how great is the embarrassment of the physician in such cases in arriving at a correct diagnosis.