The muscles have been examined in two ways—in the course of a general post-mortem examination, and also during life by means of excision or extraction by various instruments. Griesinger in 186450 excised a piece of the deltoid in a boy of thirteen,51 and made on it, with Billroth, the first microscopic examination of the diseased muscles. Duchenne, to avoid an operation not devoid of danger for the patient, devised his harpoon, by means of which small fragments of muscles could be torn away. As this instrument is liable to change the relations of the parts separated by tearing, Leech has contrived another, in which the fragment is removed by cutting. By one method or another of harpooning the muscular lesions have been studied during life by Duchenne, Heller, Wernich, Russel, Eulenburg, Martini, Knoll, Rakowac, Friedreich, Ross, Gowers, Auerbach, Hammond, Pepper, in the cases already quoted.
50 Archiv der Heilkunde.
51 The wound suppurated for a long time.
Muscular Fibre.—There are contradictory opinions in regard to the first stage of alteration in the muscular fibres. According to most observers, the fibres are seen to directly atrophy; the transverse striæ become dim and gradually disappear, and the primitive bundles shrink in diameter from loss of some of their fibrillæ (Brieger, Hammond, Pepper). Friedreich52 adds that the complete collapse of the contractile substance in the primitive bundles often leaves empty or shrunken sarcolemma sheaths, which swell the mass of the connective tissue. Friedreich, however, denies that the striation is modified; and its extreme fineness, commented upon by Duchenne, is considered by Ollivier53 and Ranvier as devoid of pathological significance.
52 Loc. cit., p. 300.
53 Des Atrophies musculaires, Thèse d'Agrégation.
The real size of the primitive fibres is best estimated by the method of Cohnheim, who isolated the fibres by boiling the muscular fragment from four to six hours in a mixture containing 100 c.c. of 90 per cent. alcohol and ¾ c.c. of concentrated muriatic acid. Many were found reduced to one-fifteenth or one-sixteenth their normal size.54 Between atrophied fibres lay a peculiar striped tissue, probably composed of empty sarcolemma sheaths. Side by side with these atrophied fibres were many normal, and others grossly hypertrophied to two or even three times the normal calibre. These were only found in the hyper-voluminous muscles. Some of these exceeded the largest frog-muscle fibres. They lay in bundles of four to six between the small fibres, and seemed to be about equally distributed through the hypertrophied gastrocnemius and atrophied biceps.55
54 Berlin. klin. Wochensch., 1865, No. 56.
55 Hypertrophied fibres have also been seen by Knoll (Medizin Jahrbuch., Wien, 1872), Müller, and Eulenburg.
Another alteration observed in the muscular fibres was their dichotomous and even trichotomous division. This same lesion has been seen by Friedreich in progressive muscular atrophy.