A system of medicine / by many writers.

Date:
1911
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / by many writers. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    Striimpell, in 1891, described another case, with necropsy, and summed up the leading features of the disease. Since that date several cases with necropsies have been reported, and, according to Lorenz, 15 undoubted examples of polymyositis with the characteristics of dermato-myositis are on record. Etiologii.—The causation is obscure. Neither of the two hypotheses, (i.) that the disease is due to a toxin, and (ii.) that it depends on an animal parasite belonging to the order of the Gregarinoidea, has been proved. It is possible that some of the cases may have been due to Trichinella spiralis (Wagner's case); but such cases should obviously be excluded from this group. Careful examination of the muscles has given a negative result, both bacteriologically and as regards Trichinella sjnralis. The suggestion that the condition is due to a toxin derived from the ingesta receives some support from the cases observed by Senator and by Kell; for in the case reported by the former the disease followed the eating of some stale crabs, and in the latter the ingestion of a fish, by which three persons were said to have been infected, one of whom died. In Senator's case the disease did not appear till some time after the crabs were eaten ; whereas in Kell's cases it came on within a few hours, though the cases were not simultaneous; the case in which symptoms appeared first proved fatal. The suggestion that the disease is due to a gregarine is based on the occurrence in the lower animals of myositis due to a protozoon, a sporozoon belonging to the order Gregarinoidea; and it is also stated that in a hog affected with gregarinal myositis, Virchow observed a skin lesion very similar to that seen in the acute polymyositis of man. In this connexion, however, the researches of Pluymers on the Sarco- sporidia (vide also Vol. II. Part II. p. 103) may be of interest as shewing how small may be the irritation to which they may give rise. The disease has supervened in the course of diabetes, tuberculous disease of the lungs and of the intestines, and after injury to the tongue. Litten and Solders have shewn that a form of myositis occurs after poisoning with carbonic oxide. Myositis due to syphilis should not be classed under this heading. There is no evidence that the disease is contagious, except perhaps that brought forward by Lewy, the nature of whose cases may well be called in question. Age and Sex.—Out of the 11 cases collected by Pfeifter, 4 were women and 7 were men. The youngest patient was seventeen, and the oldest a man seventy years of age. Schiiller published a case of polymyositis in a boy seven years old, and has collected other cases of a similar kind. Pathology.—Almost any or all the muscles of the body may be affected, but the masseters and the ocular muscles usually escape. The muscular tissue is swollen and of a yellowish-white colour, and appears covered with brownish - red patches. Haemorrhages can be seen in the muscle. Sometimes the most striking feature about the muscle is its soft and friable state. Microscopical examination shews both a
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