In view of theoretical deductions and the positive results obtained in the above experiments, it would seem probable that the production of waxy degeneration depends upon the action of lactic acid which is formed by the living muscle under the stimulation of infecting bacteria or their toxins, the formation of large amounts of lactic acid and its accumulation being perhaps favored by defective circulation through the injured muscle. The hyaline transformation of muscle acted upon by lactic acid is analogous to the swelling of fibrin placed in dilute acids. This view is supported by both negative and positive experimental evidence—the negative evidence being that simple anemic necrosis, aseptic or antiseptic autolysis whether in vivo or in vitro, or the action of bacteria of various sorts on muscle in vitro, are all incapable of causing changes in muscle cells resembling those characteristic of waxy or hyaline degeneration of striated muscle. The positive evidence consists in the demonstration that lactic acid, even in dilutions comparable to the amounts that can be formed in living muscle, can produce a similar or identical waxy transformation of the striated muscle fibers, both in vitro and in vivo; and also the observation that muscles stimulated to exhaustion, under which condition lactic acid is known to accumulate in the muscle, show microscopically changes identical with those of Zenker's waxy degeneration.

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