Passing over the loss of muscular tissue which takes place in tuberculous subjects in proportion as the disease progresses, a loss the study of which belongs more properly to the section of trophic disturbances, we may consider for a moment the inflammatory pro cesses of which I believe the muscles are often the seat in persons suffering from tuberculosis. We very frequently, in fact, hear plithisical patients complain of pains in the extremities, especially in the legs. While not forgetting the algetic symptoms referable to cachetic phlebitis, it seems to me that we are justified in regarding some of these painful sensations as of muscular origin. If we pal pate carefully the muscles of the legs, more especially those of the calves, we shall find that pressure excites more or less pain which I believe is due to the presence of myositis.
In addition to this form, which I may call latent, in which the symptoms are rather vague and indefinite, there is a tubercular myo sitis characterized by unmistakable signs. Delorme and Ileverdin made an important contribution to the literature of tubercular inyo sitis in a paper read by them before the French Surgical Congress in 1891. Although this affection, and particularly its treatment, belongs rather to the domain of surgery, I cannot omit all mention of it in a treatise on diseases of the muscles. The patients are usually young and often in apparent health. Delorme had observed the disease in young people whose appearance would never suggest that they were the subjects of bacillary infection. This author reported a case of tubercular myositis affecting the pectoralis major muscle, in which he noticed a swelling the size of a small hen's egg in the body of the muscle. The skin covering it was of a purplish color. There was no
fever present. Upon incision the great pectoral was found to be almost completely invaded by a soft mass unmixed with pus or ex travasated blood. A diagnosis was withheld and even the micro scopical examination did not remove the doubt as to the true nature of the disease. It was evident that myositis was present, but there was nothing to establish its tubercular nature. The course of the disease, however, left no doubt as to its character, for the patient soon began to cough, he became emaciated and presented all the symptoms of a tubercular phthisis, and the autopsy confirmed the diagnosis made ham ritam.
Delorme reports three other cases of sclerosing tubercular myo sitis, and he draws particular attention to the difference existing be tween this and the suppurating form of tubercular inflammation of the muscular tissue. In the latter disease there is simply a cold abscess formed in the substance of the muscle, either occurring idio pathically or following tubercular disease in the osseous or articular structures.
The only local treatment that is indicated in these cases is opera tive, but before undertaking this we must consider the general condi tion of the patient. As in all other forms of tuberculosis, our efforts should be directed toward putting the patient iu the best possible state to resist the bacillary invasion. He should live under the most favorable hygienic surroundings, have a plentiful allowance of nutri tious food, and be fortified by appropriate tonics for his struggle against the invading bacteria.
As to the prognosis, it is easy to comprehend its gravity, I was going to say its fatality.