SURGICAL COMPLICATIONS AND SEQUELS OF FEVERS. 49 



fragile, and when the}'- are called into play by the distension 

 from meteorisin, b}' the efforts at coughing and other violent 

 respiratory acts, b}' defecation, rising in bed, the movements 

 of the legs, etc., they rupture with the greatest ease. Spasm 

 or direct violence does not seem to have been noticed in any 

 case. The arteries, which have also undergone an analogous 

 change, are involved in this rupture, and muscular hemorrhages 

 result. These assume three forms, according to their size and 

 mechanical limitation: 1, ecchymoses ; 2, difluse infiltration 

 into the muscular tissue, soaking it with blood; or, 3, distinct 

 hoematomata, the last being the most important and probably 

 the most frequent. The effused clot, at first hard, well defined, 

 and sharply limited, graduall}^ softens and not infrequently 

 suppurates, thus producing serious abscesses which, unless 

 opened, may even burst into the peritoneal cavity.^ Meanwhile 

 the swollen muscular fibres gradually undergo re-absorption, 

 until, finall}', they disappear entirel}^, and a new formation of 

 cells takes place in the perimysium, which, accordino- to 

 Hoffmann, first become spindle-shaped, then coalesce endwise 

 with one another, and gradually assume the appearance of 

 striated muscular fibre. Complete repair is then effected. 

 The resemblance of these spindle-shnped cells, which are nascent 

 muscular fibres, to tlie muscular fibre-cells is most striking, 

 and seems to form a link connecting the two forms of muscular 

 tissue, the striated and non-striated, such as I have long 

 taught to be probable. 



Almost all of the muscles may be thus invaded, but 

 the favorite seats both for the degeneration and the hoemato- 

 mata are in the recti abdominis and the adductors of tlie thigh, 

 tlien in the pectorals, and, as Hoffmann has noticed in 16 

 cases out of 22, in the diaphragm. The influence of the 

 phrenic lesion in enfeebling tlie respiration is, perhaps, more 



' "VVenzel Gruber in Jacops' Thesis, p. 42. 

 4 



