XXVII. Diseases of the Muscles.
Acute Myositis.
Synonym:—Acute polymyositis.
Definition:—An inflammation of the structure of the voluntary muscles, which exhibits itself in either an acute or sub-acute form.
Etiology:—The disease seldom follows muscular strain or direct injury, as would be supposed, but develops because of the presence of some toxin in the muscle structure, although no specific micro-organism has been isolated. It is more frequently observed in males, and occurs during middle life. It has appeared during the course of severe infectious fevers and diabetes.
Symptomatology:—The disorder develops slowly, with a gradual increase of rigidity of the muscles, usually of the limbs, first with soreness and finally pain and swelling. All movement is difficult and painful, and finally serum infiltrates into the structures, producing an edema which may become general.
There is marked malaise and indisposition to physicial exercise. There may be slight chilliness with a mild fever and nausea and vomiting and loss of appetite and an inability to masticate or swallow food from involvement of the muscles of the head and neck. Constipation is common. Acute inflammation of contiguous organs may occur during its course. As the disease progresses the tongue may become dry and coated with a brown coat, and the mucous membranes are dry and dark colored, resembling a typhoid condition without the characteristic fever. In most particulars the symptoms very closely resemble those of trichina spiralis.
Treatment:—The treatment will consist of echinacea in ten drop doses, and Cimicifuga in drop doses, every two hours. Aconite may be indicated for the fever, and its action will enhance the influence of the other remedies. The indications for arnica in small, frequent doses will be conspicuous in some cases. If the tongue is dark with dry mucous membranes, give turpentine internally in five drop doses every two or three hours. The indications for acids must be met also, if present. Hydrochloric acid may be given after eating.
Externally antiphlogistine should be applied for twenty-four hours, and it may be necessary to reapply it for the same period every four or five days. In the interval the application of the diluted distilled extract of witch hazel, or diluted arnica, or arnica and sweet milk when the soreness is extreme, will be of service. Apocynum should be given if the edema becomes conspicuous, especially if there is any heart weakness.
There is a form of myositis in which permanent hardening—an actual ossification—takes place in the structure of the muscle. This is known as ossifying myositis. It is of rare occurrence. It occurs in males in early adult life. The actual cause is unknown. Calcareous matter is deposited into the sheaths of the muscular fibrillae and around the joints, producing permanent rigidity. No treatment has as yet exercised any beneficial influence upon the disease.
