Caseous Tumours found in the Muscles of the Hahe. 460 



sequestrum, the several layers of granulation tissue, the 

 altered muscular fibres in tlie deeper layer of the capsule, 

 and the altered muscular fibres outside, showing the earlier 

 changes in and between the muscles, are all very characteristic, 

 so that although no micro-organisms are to be distinguished 

 at this stage, we cannot be sure that they have not been 

 present, in fact we are almost compelled to arrive at an 

 opposite conclusion. It must be remembered, however, that 

 physical characters here come in to assist in giving rise to 

 the appearances presented. The degeneration of the muscle 

 fibres brings about a complete loss of contractile power 

 and of elasticity. The muscles surrounding them, still 

 retaining their contractility, draw upon the inelastic mass, 

 and fracture takes place in various directions, and as the 

 granulation tissue grows between the muscles, they become 

 atrophied and can no longer contract, whilst those outside 

 still draw irregularly on the outer layer of granulation tissue, 

 and thus assist in all probability in separating the granulation 

 layer from the softened or softening sequestrum within. Not 

 only so, but the presence of the mass of dead muscle un- 

 doubtedly acts as an irritant, and so helps to bring about the 

 formation of the extremely vascular granulation tissue. The 

 fact that there is material to be absorbed, stimulates the 

 tissues to the formation of an absorbing membrane. 



If the mass is not of parasitic origin, the only other possible 

 explanation appears to be that the coagulative necrosis has 

 been set in during life, after some violent muscular exertion, 

 the only fact in support of this being that most of the 

 masses were found in the muscles which are most frequently 

 and most violently exerted. 



Here the changes are explicable on the theory that the 

 coagulated muscle elements become fractured, are separated 

 from the surrounding muscular fibres, and that they by their 

 presence as dead material act as irritants; a granulation 

 tissue is formed between and around them ; and they are 

 gradually absorbed. 



Should opportunity offer, I hope that Fellows of the Society 

 will place parts of similar morbid masses in my hands, in 

 order that I may continue the invCvStigation. 



