This chapter discusses the various ways in which the relationship between kingship, violence and non-violence was conceptualised in ancient India during the period c. 500 BCE to 500 CE, both in general terms as well as in special relation to punishment and war. Examining a variety of textual, epigraphic and visual sources, it identifies a strong and enduring tension in ancient Indian political thought between the ethical principle of non-violence and the pragmatic need for the king to use force while discharging his duties. While non-violence was considered a laudable virtue, there was an acknowledgement, even in Buddhist and Jaina thought, that it was incompatible with political power. At the same time, a distinction was made between necessary force and force that was unnecessary, disproportionate, random or excessive. The former was accepted, the latter condemned. Moral and pragmatic arguments for the measured use of force were accompanied by a constant emphasis on self-control as a desirable royal virtue. By the middle of the first millennium a ‘classical’ model of kingship had emerged, wherein the king’s violence was legitimised and aestheticised. Nevertheless, a window for critiquing the potential and actual violence of the king remained.

Infectious polymyositis is an entity in which there is generalized muscle damage (rhabdomyolysis) caused by an infectious agent. The syndrome of rhabdomyolysis is characterized by elevated serum creatinine phosphokinase (CPK) concentrations and myoglobinuria leading to renal dysfunction. The muscle injury in rhabdomyolysis occurs in a generalized pattern and lacks a specific focus of abscess or infection as is seen in pyomyositis. The entity of pyomyositis is discussed in a separate chapter, Chapter 22, Deep Soft-Tissue Infections: Necrotizing Fasciitis and Gas Gangrene.

A variety of precipitating factors can lead to rhabdomyolysis. These include crush and compression injuries, drug and alcohol ingestion, metabolic and electrolyte disturbances, hypothermia and hyperthermia, and a variety of miscellaneous infections. This review focuses on infectious causes. It is important to distinguish rhabdomyolysis caused by a pathogen from that caused by sepsis, hypotension, or electrolyte imbalances that accompany a severe systemic infection.

VIRAL INFECTIONS

The wide spectrum of viral infections that have been reported to cause rhabdomyolysis are listed in Table 71.1. Influenza is the most common viral etiology reported to precipitate rhabdomyolysis, followed by human immunodeficiency virus (HIV) and enteroviral infection. The presenting symptoms in these patients include myalgias, weakness, muscle tenderness, and edema. Whether the association with influenza results primarily from a special predilection of the virus for the muscle tissue or frequent reporting of the association because of physician awareness and relative ease of diagnosis is unclear.