Paralyses : cerebral, bulbar and spinal : a manual of diagnosis for students and practitioners / by H. Charlton Bastian.

Date:: 1886

Credit: Paralyses : cerebral, bulbar and spinal : a manual of diagnosis for students and practitioners / by H. Charlton Bastian. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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$part of the convexity, in the cases in which the abdominal muscles are first atrophied ; whereas, in cases of atrophy of the lumbar muscles, the concavity of the back is less marked, and the maximum projection in front is rather above than below the level of the umbilicus. (5).—In another class of cases progressive muscular atrophy becomes associated with lab i o - glo s s o-lar y ng eal paralysis (p. 361). In these cases the affection of the bulbar ganglion cells may pre- cede, occur simultaneously, or follow towards the close of the spinal affection. It is a peculiar fact that there seems to be no particular tendency for ' ophthalmoplegia externa' to occur in this connection, although it is generally supposed to be caused by an atrophic process essentially similar to that met with in the spinal cord in progressive muscular atrophy, taking place, however, in the ganglion cells composing the nuclei of the ocular motor nerves in the floor of the Sylvian aqueduct. Curiously enough, ophthalmoplegia externa occurs, at times, with locomotor ataxy rather than with progressive muscular atrophy. Notwithstanding the name progressive muscular atrophy it is important to hear in mind that the disease is not necessarily and fatally progressive. It may limit its manifestations to certam muscles, and then become arrested spontaneously. In other cases, though the disease is distinctly progressive for a time, its advance may, after a while, perhaps under the influence of treatment or improved con- ditions of life, come to a standstill. re . a The atrophy which has been caused by over-use of the affected group of muscles is very likely to limit itself; while on the other hand, where we have to do with an hereditary tendency to the disease, the disease itself is especially prone to become generahzed. Again, it is important to remember that in certam except.ona cases the disease begins in a sub-acute manner, and may be associated with so much pain and tenderness in joints as to be mistaken for sub- ■ acute rheumatic fever. I have seen one remarkable case of this type in which, with an antecedent history of syphiUs there was much ex^ posure to wet and cold, speedily followed by -^^^)'\]''^\^2Ztllt tenderness and, in the course of two or three weeks, the mos notable llLr atrophy of nearly all the muscles of the ^^Pe-^--- .and of those connecting it with the scapula and trunk. Under active$