GENERAL SYMPTOMATOLOGY - DISEASES OF THE MUSCLES.
We know that the muscles of the body are of two sorts—those of organic life, involuntary with smooth fibres, and voluntary muscles with striated fibres. The latter only will concern us here. The alter ation in the muscular tissue may constitute in itself the entire dis ease, but most commonly it is encountered in connection with some general disorder. In the latter case the patient presents himself with all the symptoms of the primary affection to which are superadded the local signs due to the muscular this lesion exists alone there are few general symptoms other than those due to the acute muscular phlegmasia. The patient has some elevation of temperature and loss of appetite, but only in that clinical form which will be de scribed under the heading " acute primary infections myositis" is the general condition one of alarming gravity.
As regards the local lesions, the diseases of the muscles present a certain number of characteristics by which they may in general be readily recognized. These may be classified under physical and functional symptoms.
Physical Siy»s.—Ea every medical examination two of our princi pal means of investigation are inspection and palpation, and these are also the two factors by means of which we gain an idea of the morbid condition of a muscle or of a group of muscles.
By inspection we determine the size of a muscle, its form, and the coloration of the integuments covering it; by palpation we appreciate the changes in consistence and elasticity, and also learn what altera tions of temperature, if any, there are in the part.
As regards volume, a diseased muscle may present various modi fications; it may be increased in size, swollen, hypertrophied, or atrophied. In inflammatory affections of the muscles, either primary or secondary, we note most frequently a tumefaction, a swelling of greater or less extent, of the diseased part. It is not unusual also to find oedema of the overlying tissues. These are the phenomena as sociated with phlegmasic states. In chronic affections we may find atrophy or hypertrophy. We must, however, first eliminate that
form of hypertrophy which is called physiological. Tinder the in fluence of exercise we often see a group of muscles attain a size much greater in proportion than that of other muscles of the body. This is because of its functional activity which leads to a greater supply of blood to the part and consequently increased nutrition. As in stances of physiological muscular hypertrophy I may mention the large muscles of the right arm and leg of the fencing .master, the hypertrophied biceps of the gymnast, the large calf muscles of the ballet dancer. But in this there is nothing pathological, and if cer tain muscles are developed out of proportion to others the only harm resulting is a loss of symmetry. Indeed, not only have the muscles preserved all their strength and vigor but they possess these quali ties in even greater degree.
Pathological hypertrophy, on the other hand, is most commonly a false hypertrophy. The muscle has actually undergone a deterio ration, a degeneration; it is no longer the powerful contractile tissue which imparts movement to the osseous levers, but it has been in vaded by an inflexible, inelastic substance which gradually robs it of its distinctive properties. Pathological hypertrophy might there fore be regarded strictly as a simple atrophy.
Atrophy is a condition which often affects the muscles. They are then seen to he more or less diminished in volume; the normal prominences of the bony framework become more noticeable, and in advanced cases it is often possible to distinguish clearly all the con tours of the bones, the affected part presenting almost the appear ance of a naked skeleton.
The altered coloration of the skin may attract attention. In acute diseases there is usually a redness of the integument of greater or less intensity.
Finally inspection enables us to appreciate deformity in the re gions under the influence of the muscular trouble. As a result of in flammation the muscle may be shortened and retracted, giving rise to malpositions of the affected limb.