50 THE TONER LECTURES. 



serious than has been recognized. Zenker gives the adductors 

 the first i^lace, and Hoffmann reports the adductors involved 

 in the degenerative changes in '15 out of 107, tlie recti in 87 

 out of 127. While this may be true of the degenerative 

 process, yet the hfematomata are certainly most frequent in 

 the recti. Of sixty positions in cases I have collected from 

 every side, they were in the recti in 27, and the "abdominal 

 muscles" in 9, in the adductors but 5 times, and the upper 

 extremities but twice.^ If in the adductors, they may buiTOW 

 so as even to strip off the periosteum from the bone. Hjema- 

 tomata are even found in the inter-ventricular septum of the 

 heart itself. 



Stokes suggests that febrile deafness and hoarseness may 

 result from a similar degeneration of the muscles of the ear 

 and the larj-nx. There are no post-mortem examinations on 

 which to found such an hypothesis, and the fact that hoarse- 

 ness and deafness are so often not seen, and that, as I have 

 shown,^ other and sufficient causes are found at least in the 

 larjMix, render the idea scarcely tenable. 



Typhoid was the preceding fever in 44 out of 46 cases, but 

 the severity of the fever seems to have but little influence. 

 Nineteen out of 25 cases occurred from 15 to 25 j'ears of 

 age, and 22 were males as against 8 females. They rarely 

 appear befm'e the third week, since the muscular fragility is 

 then at its height. Of 23 cases I find 19 arose in the third, 

 fourth, and fifth weeks of the fever. Regeneration of the 

 muscles usually begins at the third or fourth week, and is 

 accomplished by the seventh, after which time they do not 

 appear. Their period of development is therefore quite sharply 

 defined by the anatomical history. 



As in dislocation of the hii>joint, the symptoms are often 



' In the recti they are, I believe, invariably below the navel, possibly 

 on account of the absence of the support derived from the liueaj traus- 

 versae. 



2 Ante, p. 25. 



