VOLUNTARY MUSCLE. 759 



muscle fibres (see page 100). When the wound does not gape, so that 

 the severed ends are not much separated, there may be, it would seem, 

 a direct re-establishment of muscular continuity by new development 

 of muscle, without the formation of much new connective tissue. 



Haemorrhage. This may occur as a result of mechanical injury; from 

 rupture of the fibres by convulsive contraction, as in tetanus ; or it may 

 occur when the muscle fibres are degenerated, as in typhoid fever ; or iii 

 connection with certain general diseases, as scurvy, purpura, haenior- 

 rhagic diathesis, septicaemia, etc. The blood is usually readily absorbed. 



Embolic Infarction of Muscles in connection with heart disease has been 

 described in a few cases, but it is rare. 



INFLAMMATION. (Myositis.) 



Suppurative Myositis. In the early stages of this lesion the muscle is 

 hyperreinic and oedematous, and the interstitial tissue more or less infil- 

 trated with small spheroidal cells. If the inflammation becomes intense 

 there may be an excessive accumulation of pus cells, either diffusely in 

 the interstitial tissue or in larger and smaller masses. Hand-in-haud 

 with this cell accumulation occur degenerative changes in the muscle 

 fibres. By pressure their nutrition is interfered with and they undergo 

 granular, fatty, or hyaline degeneration and necrosis. They may com- 

 pletely disintegrate ; or gangrene may occur, so that larger and smaller 

 masses of the infiltrated muscle tissue become soft, foul -smelling, and 

 converted into a mass of detritus in which but little muscle structure can 

 be detected and which is intermingled with bacteria. In other cases 

 there may be larger and smaller abscesses formed in the muscle, the 

 muscle tissue itself degenerating and disintegrating and mixing with the 

 contents of the abscess, or being pressed aside and undergoing atrophy 

 and degeneration. In some cases, when the formation of pus is moderate 

 in amount, there may be restoration by formation of granulation tissue 

 between the muscle fibres. This becomes gradually dense and firm, and 

 leads to more or less atrophy of the muscle fibres by pressure. 



Acute suppurative myositis may accompany wounds ; it is very com- 

 mon in acute phlegmonous inflammations of the skin and subcutaneous 

 tissue, and often accompanies acute infectious diseases, such as pyaemia, 

 erysipelas, etc. In most cases the " pyogeuic " cocci are present in the 

 inflammatory foci. Suppuration not iufrequeutlj* occurs in the muscles 

 adjacent to the inflamed mucous membranes in diphtheria. 



Chronic Interstitial Myositis. In this lesion there is a new formation 

 of connective tissue between the muscle fibres or bundles of fibres. This 

 new issue is sometimes very cellular, resembling granulation issue, and 

 this probably represents an early stage of the disease. In other cases 

 (Fig. 499) dense cicatricial tissue crowds the muscle fibres apart, induc- 

 ing atrophy in them, and sometimes leading to their complete destruc- 

 tion. This lesion, the analogue of chronic interstitial inflammation of 



