SYMPTOMATIC MYOSITIS - DISEASES OF THE MUSCLES.
we consider the importance of the muscular tissue in the organism, we may well imagine a priori that every general disease ought to affect it more or less; and iu fact lesions of the muscles have been observed in a very large number of general diseases. Often, however, these lesions are overshadowed or even remain with out any external sign of their existence, whence it results that the study of these forms of myositis belongs almost exclusively to the domain of pathological anatomy.
I shall divide the study of symptomatic myositis into four sec tions. In the first we shall study the muscular inflammation caused by fevers and infectious disease properly so called; in a second we shall consider rheumatism of the muscles; in a third syphilis, and in a fourth tuberculosis.
The type of symptomatic myositis occurring in fevers is fur nished by the myositis complicating typhoid fever. It is to Zenker and Waldeyer that we are indebted for our first knowledge of this variety of muscular inflammation. Hayem has completed the work of these authors and has directed special attention in a number of interesting articles to the subject of secondary infectious myositis. The occurrence of myositis has been noted in typhoid fever, small pox, scarlatina, measles, erysipelas, diphtheria, pernicious jaundice, infectious endocarditis, and glanders. We may indeed assert that all infections diseases, whether the micro-organism be already recog nized and isolated or whether its presence be only suspected, may lead to muscular inflammation. In this category I do not hesitate to include influenza, although we have as yet no anatomical proofs es tablishing a connection of this sort. I find my justification for this inclusion in a case observed by me during the epidemic of 1889-90. A young man of twenty-one years, without any constitutional taint, was attacked by the grippe and presented symptoms of broncho pneumonia and of gastrointestinal disturbance. The patient had a rather long period of convalescence, but he finally recovered and by the end of two mouths his attack was nothing more than a memory. At this time, while mounting a horse he suddenly,• without being conscious of having made any special effort, felt a sharp pain in the upper and anterior part of the left thigh. He was unable to continue
riding and could not even return to his home on foot. Upon exam ination a very severe pain was found localized in the adductors, and in the course of the following days an ecchymosis of the skin cover ing this portion appeared and confirmed the diagnosis which had been already made of rupture of the muscle. I am convinced that this rupture lied been made possible by a myositis due to the action of the grippal infection.
Hayem, in the work above referred to, gives the following table: Among all infectious diseases two are of special importance from the point of view that now concerns us, viz., typhoid fever and small pox, to which I would add measles, a disease which was the proba ble cause of a sclerosing myositis in a case recently reported by Gaucher and Marage.
Pathological Anatomy.—At the autopsy the muscles are found swollen and rigid; their color may vary from a dark red to brown ish ; in their substance are seen points of rupture of the fibres and small hemorrhagic or purulent foci.
Hayem describes three degrees of symptomatic myositis. In the first degree the lesions are not very clearly marked; the muscles are indurated and swollen, and their color is darker than normal. Under the microscope the muscular fibres present a granular or sometimes waxy appearance, and there is seen to be a beginning increase in the nuclei of the muscular cells and of the internal perimysium.
In the second degree the muscular tissue is seen to be paler; cer tain of the bundles are of a grayish-pink color, others are yellowish or whitish. There is also an extravasation of blood, and the tissue becomes very brittle. Under the microscope we find the lesions of the first form in a more advanced state ; the altered fibres are broken, the nuclei are much increased in number, and we recognize the lesions of granular and waxy degeneration. Fatty granules are found espe cially in the granular degenerated fibres ; the waxy fibres are broken into larger masses.