Hypertrophy In The System Of Voluntary Muscles

Hypertrophy In The System Of Voluntary Muscles, to an extent that would be called morbid, and would essentially disturb the functions of the part, is extremely rare, the tongue and a few of the respiratory muscles alone excepted. But it is very frequently observed in the heart, and in the muscular coat of the alimentary tube and bladder. The degree which hypertrophy attains in these organs is often exceedingly great. It is mostly due to some mechanical obstruction, to increased action and overstraining of the organ, to immoderate innervation, or, as in the instance of the bladder, to catarrh of the mucous membrane. After having reached a certain degree, it ends in palsy of the organ, and in this manner may destroy life of itself, and suddenly, or it may lead to various consequences, such as ileus in the intestinal canal, and inflammation and sloughing in the bladder, which in the end are fatal.

The deformities have partly been mentioned amongst the faults of development; the remainder are merely those which are produced by retraction, atrophy, and hypertrophy.

3. Variations In Color

The color of muscles varies much under different circumstances. Thus, as will appear in the latter parts of this chapter, diseases of their texture are attended by changes in their color. When there is general emaciation, in dropsical subjects, in cachectic cases, such as rickets, tubercle, and chlorosis, after hemorrhages, etc, and in paralyzed limbs, the muscles are paler than natural: in advanced life they have a pale rusty brown, or a dun color. Muscles which waste in consequence of permanent spasmodic contraction, have a grayish or yellowish-red hue, and at length become dirty white; when the atrophy is the result of steatosis, they are yellowish-red; and so on. On the other hand, hypertrophied muscles are of a deep-red color; and those of persons who have died of typhus, acute convulsions, Asiatic cholera, or hydrophobia, of patients with scurvy and cyanosis, and of persons suffocated, are of a dark purple-red color, with a shade of blue or violet. Muscles in the neighborhood of collections of pus or sanies become brownish-green, or greenish-blue.

4. Deviations Of Consistence

There is usually some connection between the deviations of color and those of consistence: when muscles lose or change color, they mostly become less firm; and when they have a deep-red color, their consistence is increased. Muscles thus altered may be in an unnaturally lax, supple, soft, and friable condition; or they may be compact and tough; or, again, though firm and glistening, they may be dry and easily broken. Thus, in the forms of cachexia just mentioned, the muscles are not only pale but lax; in old age and steatosis they are discolored, and soft, they tear very easily, and may be squeezed into a pulp; whilst on the contrary, spasmodically contracted muscles are tough, notwithstanding their loss of color. Hypertrophied muscles are firm and strong, and so are those of patients who have died of acute convulsions or hydrophobia, and especially after Asiatic cholera: in the last-mentioned cases they are also remarkably dry.

A still more marked instance of diminution of the consistence of muscles occurs in dropsy, and in the neighborhood of inflammation and abscess. The muscles in these cases are not only bleached and discolored, but also macerated. A peculiar softening of the muscular coat to a gelatinous substance is sometimes produced by the action of the acids of the stomach and intestines: not unfrequently the process reaches beyond the stomach and involves the diaphragm.

5. Solutions Of Continuity

In this class are included flesh-wounds of various kinds, and the lacerations and contusions of muscles produced by external violence; some of them are unattended by any injury to the integuments, whilst, in other cases, that and other structures also are more or less hurt. Muscles are subject to spontaneous rupture, giving way now and then during violent convulsions. The accident, however, is a rare one in any muscular structure but the heart. I have, on several occasions, met with ruptures of the recti abdominis muscles, which had been produced by the convulsions that occur in the course of ileo-typhus. Not unfrequently a few of the muscles of the limbs are found ruptured in the dead body, and the occurrence may be traced to excessive postmortem rigidity. I have observed it most frequently in the biceps muscle of the arm. It may be distinguished as having taken place after death by the absence of any effusion of blood, and still more certainly by there being no trace of reaction.

The muscular coats of hollow organs do not usually escape laceration when the serous and mucous membranes, which invest them within and without, are violently torn; but sometimes the rupture is confined to the muscular coat. Not unfrequently it gives way in consequence of extreme distension, as for instance in the stomach, the intestine, and the bladder.

A wound of a muscle, though unattended by any loss of substance, can be repaired only in the same manner as one in which substance has been lost, for the retraction of the surfaces of the wound places the former in the same condition as the latter. Subcutaneous ruptures, those in which there is no corresponding injury to the superjacent integuments, and no exposure of the wound to the air, heal readily by the first intention: the surfaces become slightly inflamed, and a reddish, gelatinous exudation is effused, which fills up the space. It gradually changes into a reddish vascular cellular tissue, which at first unites with the surrounding inflamed cellular tissue, but afterwards separating again from it, is converted into a denser, white, leather-like (cellulo-fibrous) callus.

Flesh-wounds, which are complicated with injury to the integuments over them, and are consequently exposed, heal by suppuration and granulation. The granulations fill up the cavity of the wound, and changing into a dense white callus of the same kind, as in the former mode of repair, they unite the surfaces of the wound together. In such a case the inflammation extends beyond the wound for some distance along the muscle, and converts it into a cellulo-fibrous tissue, in which the muscular fibre disappears. The muscle is thus divided, and acquires two bellies; and not unfrequently a bursa is formed beneath the uniting callus, by which their movements are facilitated. In process of time this callus diminishes in size, partly by shrinking, and partly, perhaps, from being absorbed; and at length it may disappear almost entirely, a few traces of it only remaining.

In the stump, left after amputation, the extremities of the muscles become rounded off, and degenerate into a cellulo-fibrous tissue, and they unite in a common cicatrix with the integuments and thickened periosteum.