Volume 9

A system of medicine / by many writers ; edited by Thomas Clifford Allbutt and Humphry Davy Rolleston.

Date:
1905
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: A system of medicine / by many writers ; edited by Thomas Clifford Allbutt and Humphry Davy Rolleston. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

    29/944 (page 7)
    ]\Iicroscopically daring the acute stage intramuscular haemorrhages are found, the muscle-fibres being separated from one another by cxtravasated blood.' The muscle-fibres have lost many of their nuclei, arc vacuolated, and shew waxy degeneration. In the later stage the muscular fibres undergo extensive atrophy, the connective tissue is generally increased in amount, and blood-pigment is often present. Si/mptoms.—The onset is acute, and attended by fever and by localised pain and swelling in the muscles, usually in the calf or thigh. The muscular swelling is hard and painful to the touch, and may be surrounded by oedema of the tissues. After a time these swellings disappear, while othei’s rapidly appear elsewhere. The pain is very acute, and the move- ments of the limbs are greatly impaired. The skin is very liable to vasomotor disturbance, and any pressure may produce a bright-red spot, which persists for many minutes, or becomes purpuric. Lorenz’s patient, a man aged forty-three, previously in perfect health, was taken ill in December 1900 with pain in the left thigh; a small nodule could be felt in the muscle, which gradually increased in size for one week and then got smaller ; after a time swellings occurred in other muscles, and the patient complained of difficulty in swallowing. Swellings could then he felt in various muscles, and were hard and painful on pressure. The heart shewed slight dilatation and irregularity. During the next month fresh swellings appeared in the muscles, the skin was very sensitive to any pressure, red spots being pro- duced, which only disappeared after twenty to thirty minutes. The cardiac rhythm became more irregular, and attacks of tachycardia and dyspnoea supervened. The patient died at the end of June from cardiac failure. The muscles shewed evidence of both recent and old haemorrhages, and were of a greyish-brown colour. Haemorrhages both old and recent were present in the myocardium, but there was no valvular disease. In contrast to this fatal case is the following case recorded by W. S. Thayer;— A man aged thirty-four, who for fifteen years had suffered from “ rheu- matism,” had for several years a series of attacks of swellings in various muscles. The amount of constitutional disturbance in the attacks was not great. The skin over the swellings was purplish in colour. In one of these attacks a portion of the swelling was excised ; a large (piantity of blood-stained .serum escaped, and the tissue removed was pale and oedematous with dark haemor- rhagic streaks. Microscopical examination shewed clots undergoing rapid organi.sation. The patient recovered from the various attacks, with slight weakness and atrophy of the muscles all'ected. The tendency to the attacks remained. I'rof/nosis.—The di.sease, which is generally fatal, varies in its duration ; one patient died in ten day.s, and anotlier lived for more than .six months after the first symptoms. Polymyositis In Association with Erythema Multiforme and Urticaria. — In erythema nodo.sum it is not uncommon to find the