DEGENERATIONS OF MUSCULAR ORGANS.
The muscles, including the heart, are seats of degenerative changes, two of which are specially important.
Fatty degeneration. The muscular tissue in this form of generation is transformed, more or less, into a fatty condition, the truly muscular elements being replaced by fatty or oily particles. In this state the muscle fails to respond to the nervous stimulus, and though the structure may remain of time same size, or may even increase in bulk, it is incapacitated for active work. The heart is the muscle most frequently affected by this degeneration. Osseous degeneration. A condition in which the muscular structure is converted into calcareous or bony matter. The heart may become—as I have once myself seen it—transformed, in part, into firm bone. Osseous change is attended with little acute pain, but with permanent destruction of function of muscle in the part involved in the change.
Diseases from deposits. The muscles may become the seats of special deposits, tubercular and syphilitic, and it is probable that the involuntary muscular fibres are often the seats of syphi litic deposit, by which their action is greatly impaired, and from which impairment two diseases of the blood-vessels, namely, dila tation and aneurism, have frequent origin.
The muscles are subject to rupture or tear. The rupture may be in the structure itself. It is more commonly in the muscular sheaths. It may be caused by excessive strain or by a blow on a healthy muscle. It may occur under ordinary movement in a muscle affected or weakened by disease.
Diseases of Tendons.
The tendinous terminations of muscles called commonly the sinew are themselves devoid of contraction. They are, as it were, the membranous sheaths of the true muscular tissue con densed into one homogeneous structure at the ends of the muscular bodies. They are composed of fibrous tissue, and are enclosed in an investing web or sheath. They are the passive parts of muscle, and form the attachments of muscles to bone, by means of which the muscles pull or exert their power to move the bones. The tendons are the seats of several diseases.
Inflammation—Thecal abscess. The tendons are often the seat of inflammation, as a result of wounds in which they are in volved. A common form of inflammation of tendon is that known in the finger, called theca] abscess or whitlow, in which matter forms within the sheath of the tendon, causing a most painful local inflammation accompanied with irritation and fever. The tendons are sometimes involved in rheumatic inflammation.
Sprain. When a tendon, or a tendinous expansion, or fascia, is subject to severe stretch, or to tear, or to displacement, a sprain is produced. Sprain is a common injury, and is usually attended with external swelling, pain, and difficulty of movement in the part, lasting for several days. The tendinous expansions or fascial coverings of muscles are occasionally torn across, in places like the calf of the leg; severe injury to motion occurs from such tearings, together with great pain, swelling, sometimes ecchymosis or effusion of blood, and usually some after fever. This painful accident is called rupture of the tendinous fascia.
Adhesion. Tendons, as a result of inflammation, may be come adherent one to the other, or to surrounding parts. The effect of the adhesion is to produce more or less derangement of motion from the muscles connected with the tendon or tendons implicated.
Contraction of Tendons.
Tendons are liable to contraction, by which the parts they are connected with may be shortened or otherwise distorted. The contractions are sometimes congenital and sometimes the result of disease or accident after birth. The most common con tractions are those affecting the foot and causing the various deformities called generally club-foot.
Talipes or Clubfoot.
There are several kinds of club-foot, talipes, some of which have received different names according to the character of the deformity. The principal of these are as follow.
Talipes varus. This is the most common form of club-foot, and may be a congenital affection. The heel is drawn up; the inner side of the foot is drawn up and the toes are turned in wards. The sufferer learns to walk, in this case, on the outside of the foot.
Talipes valqus. A condition the opposite to the above, in which the heel is raised, the outer side of the foot is turned up, and the sufferer walks on the inner side of the foot and inner ankle.
Talipes equinus. A contraction in which the heel is drawn straight up, so that the sufferer walks on the toes, or on the toes and a small part of the surface of the foot.
Talipes calcaneus. A contraction in which the toes are drawn up, and the sufferer walks on the heel bone, the calcaneum, or os Weis.
Talipes calcaneo-varus.--A contraction in which the toes and inner side of the foot are drawn up, so that the patient walks on the heel and outer side of the foot.
Talipes equino-valgus. A contraction in which the heel and outer side of the foot are drawn up, so that the patient walks on the toes and inner side of the foot. This is called also "flat foot." Club-hand and contracted fascia of the Hand.
The hand, from contraction of tendons, is subject to deformi ties which are not sufficiently definite in character to admit of classification like those of the foot. The deformity called con tracted fascia is one in which the palm of the hand is con tracted, or in which the fingers are contracted on the palm. The contraction may be in the fascia or in the flexor tendons, or in both fascia and tendons. It is most usually the result of accident, as from strain, or from lifting very hot substances such as heated metal. In some persons of gouty or gouty rheumatic constitution the contraction may come on in middle life without the action of any apparent exciting cause.
Wry neck. The College authorities classify wry neck as a disease of the tendons. It is a condition which is owing to a contraction of the oblique muscle of the neck, the cleido mastoideus, the muscle which stretches across on each side from the mastoid portion of the temporal bone, near to the ear, to the junction of the sternum, or breastbone, with the inner end of the clavicle, or collar-bone. The contraction of this muscle, which the artist knows so well, causes the head to be drawn on to one shoulder, while the face looks towards the other shoulder. The sternal end of this muscle is tendinous, and the contraction may be in the tendon; but it may also arise from spasm of the muscle itself. Wry neck is most common in the young who are of mixed strumous and rheumatic constitution. It usually follows attacks of feverish affections in these. The spasmodic form may be purely hysterical in character, and in one of the worst examples of wry neck I ever knew, which was of this origin, recovery oc curred instantly from a start or fright, although the contraction had existed five years.
All these distortions from contraction of tendons are now, owing to the excellent labors of Dr: Little, Mr. William Adams and other surgeons, greatly amenable to surgical skill.
Diseases of the Appendages of the Muscular System.
Connected with the muscular system are small bodies called bursae. These are small pouches or sacs of synovial membrane, filled with synovial fluid, and placed near to joints to prevent the friction of parts gliding the one over the other. Thus there is a bursa over the wrist-joint, another over the knee-pan, and so on for other similar parts. The burgle are subject to diseases, which are classified in the following order.
Enlarged bursa of the patella. A condition in which the bursa of the patella, or knee-pan, is enlarged and distended with synovial fluid. The disease is brought on by frequent kneeling on a hard substance, and is so commonly presented by the house maid, who kneels to scrub floors, that it has obtained the name of housemaid's knee.
Wrist bursa is another name given to an enlarged bursa at the back of the wrist. It is a common disease among pianoforte players in their early life.
Bursal turnor. An enlargement of a bursa, ending in solidi fication, so as to form a hard and often painful tumor.
Bursal abscess. A condition in which matter, or pus, forms within a bursa. It is the result of inflammation, and is a con tinuation of an acute enlargement of the bursal sac. I have known it induced by a blow ignorantly inflicted on an enlarged bursa, with the object of dispersing it.
Bunion. The affection called bunion is an enlargement or thickening of the bursa over the large or metatarsal joint of the great toe. It is usually produced by the friction of a badly fitting boot or shoe.
Ganglion. —A painful swelling, resembling a bursa, formed by an enlarged cyst, or a newly developed cyst of synovial in the sheath of a tendon, or of a tendinous expanse. The swelling, if it be near to a nerve or a sensitive structure, is very painful. It may attain a large size. At first it is soft, and the presence of fluid within it can be detected; but after a time it becomes firm and solid. It is commonly produced by undue pressure and friction, or by a violent strain. When it is present in the hand, involving the sheaths of the flexor tendons, and causing one large double swelling in the palm of the hand, and another on the wrist above the ligament which runs transversely across the wrist, the affection is called in the nomenclature, " dif fased yalmar ganglion."