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the blood-stream. Tuberculous nodules are found disseminated throughout
the muscle; the surrounding tissues are indurated, and central caseation
may take place and lead to abscess formation and sinuses. We have
observed this form of tuberculous disease in the gastrocnemius and in
the psoas--in the latter muscle apart from tuberculous disease in the
vertebrae.

#Tendinitis.#--German authors describe an inflammation of tendon as
distinguished from inflammation of its sheath, and give it the name
tendinitis. It is met with most frequently in the tendo-calcaneus in
gouty and rheumatic subjects who have overstrained the tendon,
especially during cold and damp weather. There is localised pain which
is aggravated by walking, and the tendon is sensitive and swollen from a
little above its insertion to its junction with the muscle. Gouty
nodules may form in its substance. Constitutional measures, massage, and
douching should be employed, and the tendon should be protected from
strain.

#Calcification and Ossification in Muscles, Tendons, and
Fasciae.#--_Myositis ossificans._--Ossifications in muscles, tendons,
fasciae, and ligaments, in those who are the subjects of arthritis
deformans, are seldom recognised clinically, but are frequently met with
in dissecting-rooms and museums. Similar localised ossifications are met
with in Charcot's disease of joints, and in fractures which have
repaired with exuberant callus. The new bone may be in the form of
spicules, plates, or irregular masses, which, when connected with a
bone, are called _false exostoses_ (Fig. 110).

[Illustration: FIG. 110.--Ossification in Tendon of Ilio-psoas Muscle.]

_Traumatic Ossification in Relation to Muscle._--Various forms of
ossification are met with in muscle as the result of a single or of
repeated injury. Ossification in the crureus or vastus lateralis muscle
has been frequently observed as a result of a kick from a horse. Within
a week or two a swelling appears at the site of injury, and becomes
progressively harder until its consistence is that of bone. If the mass
of new bone moves with the affected muscle, it causes little
inconvenience. If, as is commonly the case, it is fixed to the femur,
the action of the muscle is impaired, and the patient complains of pain
and difficulty in flexing the knee. A skiagram shows the extent of the
mass and its relationship to the femur. The treatment consists in
excising the bony mass.

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