48 THE TONEU LECTURES. 



belly," saj's he, " is not siir[)risiiig. The organs become so 

 fragile in advanced stages of putrid fever that tlieir rupture is 

 a phenomenon which is easily conceived when the patient in 

 his delirium moves so irregularly." In 1844 Rokitansky 

 noted their relation to typhoid. Yirchow studied them also in 

 1857. In 1SG4, however, Zenker first studied the subject 

 thorougldy. Since then, but especially within the last five 

 years, they have been frequently observed or studied, mostlj', 

 however, from a pathological standpoint. 



The muscular changes to be described are so frequent as to 

 be almost an essential part, at least, of tj'phoid. Yet they are 

 not peculiar to these fevers. They are said to have been met 

 with in phthisis, scurv}^, scarlet fever, cholera, pneumonia, 

 dj^senterj', measles, tetanus, Bright's disease, cerebro-spinal 

 nicningitis, muscular traumatism, and I have seen a similar 

 change in the muscles of the abdomen, in cases of large 

 ovarian tumors. 



There are two independent forms: 1, a granular degenera- 

 tion of the muscular fibres, which is least frequent ; and 2, a 

 waxy change, which is by far tlie commonest. In the micro- 

 scope the muscular tissue presents a glass^^, translucent, 

 slightly opalescent, shin}' appearance, the fibres being swollen 

 to eA'en double their usual size, and changed to fragile 

 cjdinders. Sometimes the muscular tissue resembles even the 

 flesh of fish. The nature of the change is as yet greatly 

 disputed. Erb, Bernheim, and others attribute it simply to 

 post-mortem imbibition ; Haj'em, to proliferation of the tunica 

 intima, which, with granulo-fatty change in the arterial walls, 

 produces an obstructive arteritis ; Zenker ascribes the degene- 

 ration to the disturbance of a centre which regulates the 

 nutrition of the muscles; Waldeyer, Hoffman, Ranvier, and 

 Weihl believe that it is a coagulation of the myosin ; and 

 Liebcrmeister that it is due to the long-continued high tempe- 

 rature. Whatever the cause, the muscles become extremely 



