After having established the presence of inflammation of the mus cular tissue, we have to determine the variety of myositis that is be fore us. And in the first place whether it is a primary or a secon dary myositis—usually a matter of but little difficulty. If the patient is already suffering from some infectious disease (small-pox, typhoid fever, etc.) we must attribute the muscular inflammation to this infection. We ought also, in the case of an infectious myositis, to distinguish the particular variety with which we have to deal.
With this object in view we must bear in mind the distinctive points in the symptomatology above described.
In the case of chronic myositis it is sometimes difficult to deter mine whether we have to do with a primary myositis or with an in flammation of a rheumatic nature. Some writers, indeed, make no distinction between myositis and muscular rheumatism. We must also not' forget that both syphilis and tuberculosis may produce an of the muscular tissues.
Prognosis.—Acute simple my ositis usually terminates in recovery. Even when the inflammation proceeds to suppuration, the patient's condition is not necessarily serious, for after the evacuation of the pus perfect recovery may ensue. We may therefore regard this form of myositis as benign. It is very different, however, with infectious myositis. Here we are in the presence of a grave affection, and even when the symptoms are not of extreme severity we should always be reserved in our prognosis. The entire organism is infected and a cure is the exception rather than the rule. In the hyperacute cases the patient may be taken away within a few days, presenting symp toms of extreme exhaustion. Sometimes the disease progresses more slowly, but death follows just as surely. In a few more fortunate cases the general symptoms gradually subside and convalescence is es tablished; but despite these exceptional occurrences the prognosis of primary infectious myositis should be regarded as of extreme gravity.
In the case of chronic myositis the question of death, at least of speedy death, does not enter into consideration. The disease may occasion deformity and functional impairment, but even the most dreaded form, that described above under the name of progressive ossifying myositis, advances very slowly. We can hardly look for a cure of this disease, but its progress is so slow that a fatal termina tion through exhaustion need not be anticipated under twelve or fif teen years.
neatmeot.—The treatment to be adopted in the case of myositis will vary according to the form of the disease with which we have to do. In the simple acute form we should secure complete rest for the
patient and immobilize as far as possible the diseased parts. At the beginning we may employ blood-letting under the form of wet cups, or mild revulsion obtained by applications of the tincture of iodine or by punctate cauterizations. If in spite of this the inflammation shows no tendency to subside we must envelop the parts in a moist antiseptic dressing. If pus forms it mast be evacuated as soon as its presence is recognized. After the opening has been made the cavity must be carefully drained and washed out twice a day with a warm antiseptic solution, either of corrosive sublimate (1 :2,000) or of car folic acid (1:00). Under this treatment the suppurative process will gradually subside, and, the drainage tube being shortened each day, cicatrization of the entire cavity will eventually be obtained.
When a certain degree of rigidity of the muscle remains after an attack of acute simple myositis, or when more or less induration per sists, the parts should be smeared with Neapolitan ointment. In the chronic forms, whether following an acute attack or chronic from the outset, we must have recourse to the continuous current or to mas sage. In the case of progressive ossifying myositis the only remedy that need be mentioned is the iodide of potassium.
In the case of simple acute myositis the general treatment is usu ally of secondary importance. For the relief of the pain and the fever we may give quinine, antipyrin, or some one of the other anal gesic antipyretics. If suppuration occurs the strength of the patient must be maintained by tonics and stimulants, and the gastrointesti nal troubles must be combated by the administration of some mild laxative together with an intestinal antiseptic, such as salol, benzo naphthol, etc.
For the relief of primary infectious myositis a great number of local and general measures have been recommended. In the form characterized by a tendency to suppuration, B11111013 advises a treat ment which varies according to the particular case. In the hyper acute cases he limits his efforts to the attempt to maintain the pa tient's strength by means of stimulants and alcohol. In the less acute form he administers preparations of cinchona, and gives exit to the pus as soon as it has formed. In the mild form he has recourse to local counter-irritation or to mercurial inunctions, either alone or accompanied by the application of compresses wet in a carbolic solu tion after the method practised by Scriba of Tokio.