Progressive Muscular Atrophy of Cen tral Origin.
This is a progressive atrophy of the muscles. combined with more or less marked rigidity, usually beginning in the hands, and due to chronic degeneration of the spinal motor tract. (See SPINAL CORD.) Progressive Neural Muscular Atrophy.
This is a progressive atrophy observed in children in which tbe muscles of the feet and tbe peroneal group are usually first affected, as the result of chronic interstitial neuritis. (See PERIPHERAL NERVES.) Infectious Myositis.
The various forms of muscular inflam mation due to rheumatism, gonorrhcea, pycemia, and other infectious disorders, etc., are reviewed under the heads of the causative affections. This article only includes, therefore, the form of myositis which occurs as the result of infection.
Symptoms.—Slight fever and enlarge ment of the spleen are often noted early in the history of myositis. Swelling, stiffness, and tenderness of the muscles, slight cedema of the hand or foot, accord ing to the extremity first involved, ten sion of the skin over the affected part, represent about all the earlier symptoms observed in all cases. Apart from these, the symptomatology varies according to the causative affection. In some there are disorders of sensation greatly sug gesting a kinship with peripheral neuro ses; others so simulate progressive mus cular atrophy that a diagnosis is quite difficult. Again, trichinosis is suggested by many of the local and general mani festations, and the diagnosis cannot be established without a microscopical ex amination involving the removal of a small section of the affected muscle. Diffuse purulent infiltration sometimes follows the local inflammatory process, reaching in some cases to gangrene. An erythematous rash is sometimes observed. As the disease progresses the use of the member affected becomes increasingly impaired, locomotion being quite clif ficult and painful when the muscles of the legs are the seat of disorder. The cedema is first limited to the extremities, invades the trunk, then the face, giving the latter a bloated appearance suggest ing myxcedema. The muscles of deglu
tition, mastication, and respiration being occasionally involved, the general nutri tion greatly suffers, while dyspmea may become distressing. Inflammatory' disor ders of the respiratory' tract sometimes occur concurrently', pneumonia, even, having been observed as a terminal com plication. The affection usually lasts be tween three and four months, though chronic eases may last much longer.
Symptom so far unrecognized, namely: an effusion into the cellular tissue over the muscles after the myositis has sub sided somewhat. This effusion is not great, but it gives rise to an audible crackling that can be elicited by moving the skin over the affected muscle. One may find this especially well marked cases of intercostal rheumatism. A. G. Miller (Scottish Med. and Surg. Jour., Sept., '95).
Etiology and Pathology. — The evi dence at hand tends to show that an in fectious principle, the nature of which is. still unknown, is the direct pathogenic agent. Marked proliferation of the in terstitial tissue, fatty degeneration, or hyaline degeneration of the muscular fas ciculi have been noted microscopically (llueppe).
Six personal observations ou diffuse interstitial syphilitic myositis. A mus cular atrophy analogous to progressive muscular atrophy found with the addi tion of vascular sclerosis and the forma tion of connective tissue. AMisyphilitie treatment is always effectual in these forms. Lewin (Oesterr.-ungar. Central!). f. d. med. Wissen., May 7, '92.).
Three cases of inynsitis occurring in the second and third weeks of searlm tina after the subsidence of acute symp toms. This complication is unaccom panied by fever, and disappears rapidly, • It:, be distinguishedI•••... I .1 , July 7, '9S).
Treatment. hi a ;.-41.41. ol t'leven eilSeS f d ot tilt most satisfactory• ti... •.1 t. ii-t-ts in leeches or other L a-urts at first, and 1.dt-of-a:id ointments later • :; ,-f tlettrieity did not seem r • I t .rt•tillar.y indicated. but sys t .1- .1. n i- very valuable. Care ta however, to alternate it th mit int crvals of muscular rest.