EXTRACT XXVII. 



POLYMYOSITIS AND MYOSITIS. 



POLYMYOSITIS, as described by Sir W. Cowers and others, 

 seems to us to be secondary to, or to be in many cases 

 a continuation of polyneuritis (motor), which in turn is 

 often due to a rheumatic or allied condition, emanating, 

 as in Sir W. Gowers' case in the British Medical Journal 

 of date January 14, 1899, from repeated exposures to 

 damp, repeated chills, want of nerve and muscle rest, and 

 to the effects of living amid continuous insanitary 

 influences. 



The nightly chills to which the patient, whose case is 

 described by Sir W. Gowers, was for a long period subject 

 gave rise to nightly checks and stasis of the cutaneous 

 exhalations and excretions, with corresponding increases 

 of cerebro-spinal and intra-cerebro-spinal sepsis and pres- 

 sure, and, consequent, backflows along the channels of 

 least resistance, these channels being, in this case, along the 

 continuations of the sub-dural and sub-arachnoid spaces, 

 into the motor nerves generally, and by continuity through 

 their fibrils and nerve terminal plates into the substance 

 of the muscles to which they were supplied, and in whose 

 substance they were finally distributed. 



If we may be permitted to say it, the case was thus 

 one of auto-toxis, due to the repeated invasion of the 

 intra-neurilemmar spaces of the motor nerves, and sub- 

 sequent inundation of the intra-sarcolemmar spaces of the 

 muscles to which those nerves were distributed by a 

 regurgitated cutaneous and, consequently, effete and 

 noxious excretion, with accompanying inflammatory 



