CHRONIC MYOSITIS - DISEASES OF THE MUSCLES.
The symptoms of chronic myositis are often but slightly marked. The affection may follow an acute attack, or it may be chronic from the beginning. Careful palpation enables us to discover that the muscle is as it were thickened and at the same time painful. There may be difficulty in movement; sometimes we even find atrophy and resulting deformity.
The most interesting variety of chronic myositis is that which has been described under the name of ossifying myosins. We may dis tinguish two forms of this disease. The first is characterized by bony formations in the body of a muscle constantly exposed to slight injuries, such for instance as the abductor muscle in a cavalryman. The second variety is the disease studied by Miinchmeyer and called progressive ossifying myositis. This affection, concerning the nature and pathogenesis of which we know but little, begins during later childhood, and is characterized by an ossification of the muscles, the process starting with those of the back of the neck. There is at first a swelling of this region, which swelling gradually disappears and is replaced by an indurated nodule. This process is repeated and the work of ossification goes on, invading in turn the muscles of the back, the neck, and the shoulder. As a rule the disease lasts not less than ten or twelve years, slowly progressing toward a fatal ter mination.
Diugnosis.—Simple acute myositis is an affection the diagnosis of which is easy. The pain limited to a certain muscular region, the prominence of the affected muscle above the surrounding surface, the wooden feeling imparted to the palpating finger, leave in general lit tle doubt as to the condition present. The general symptoms, the fever accompanying pain in the extremities, may give rise to a sus picion of acute articular rheumatism, but in the latter disease the pain is most intense in the articulations, which are very evidently distended with fluid, while nothing similar is seen in myositis in which the joints are unaffected.
The symptoms might also suggest a phlegmou of the cellular tis sue, especially when a pulpy feeling or even fluctuation, indicative of suppuration, follows the primary induration. The shape of the af
fected region and the deeper situation of the bogginess felt on palpa tion will enable us to exclude a phlegmon.
In the case of primary infectious myositis the diagnosis may pre sent greater difficulties, and because of the comparative rarity of the disease it is very possible for the physician to go astray. In the presence of the grave general symptoms observed at the onset of the disease one's attention may be turned away from the muscular sys tem and directed to any one of a number of other organs. The vio lence of the fever, the loss of appetite, and the general depression may lead one to think of an eruptive fever or an acute articular rheu matism of malignant type. Thus it is necessary to eliminate cere bral rheumatism, typhoid fever, osteomyelitis, circumscribed phleg mon, pycemia, suppurative arthritis, ulcerative endocarditis, etc.
In the case of polymyositis, the symptoms may suggest glanders or trichinosis; occasionally indeed the diagnosis from the latter affection is one of great delicacy. But it should be remembered that trichinosis begins usually in the muscles of the face and in the tongue, while in polymyositis it is the muscles of the extremities that are first attacked; furthermore, in trichinosis the disease is lo calized especially in the flexor muscles of the extremities, while on the contrary it is the extensor muscles that are principally affected in polymyositis.
In order to avoid confusion with the affections just mentioned and to establish a correct diagnosis, we must carefully study the progress of the disease; the patient should be examined with attention, the exact seat of his pain being noted; by palpation we may also arrive at an appreciation of the pathological condition of the muscles. But in spite of everything, in certain obscure cases in which the deeper muscles are the first attacked, we may be obliged to withhold a diag nosis for a time.