A system of medicine / by many writers.

Date:
1911
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / by many writers. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    enlarged, and it is characterised by causing an abrupt projection just above the knee. The glutei are uniformly enlarged and hard to the touch. The flexors of the knee and the flexors and adductors of the hip-joint are usually atrophied. The erector spinae is in some cases hypertrophied, in others atrophied. In the shoulder the hypertrophied muscles are the deltoid and the supra- and infra-spinati, which are nearly always enlarged; the deltoid is very much enlarged, and if it be felt during relaxation, by passively supporting the arm at right angles to the trunk, it will be found harder than natural. Tlie condition of the supraspinatus, from its being covered by the trapezius, is more difficult to ascertain ; but the infraspinatus stands out prominently as a hard mass. Of the muscles which are wasted, the lower half of the pectoralis major arising from the sternum and the latissimus dorsi are almost invariably atiected ; the absence of the former is well shewn by making the patient advance both arms horizontally forwards, when on pressing the hands together the upper flbres alone of the pectoralis major will be seen to contract, and the sharp lower border of these fibres will be felt passing to the upper end of the sternum. Absence of the latissimus dorsi and pectoialis major (lower half) can also be shewn l)y making the patient adduct the humerus, previously raised to the horizontal line, against resistance, when no muscle will l)e seen going fi-om the humerus towards the pelvic brim, and the teres muscles will stand out, and will draw^ the scapula forwards into the axilla, and e.specially if the rhomboids be weak. The absence of the latissinnis dorsi and of the lower part of the pectoralis major can also be demonstrated by placing the hands in the axillae from behind and lifting up the i)atient, when the scapulae wnll be drawn upwards from the trunk to an extreme degree. The trapezius, rhomboids, and serratus magnus arc usually not aflected, though the last-mentioned may l)e wasted. In the arm the triceps is usually hy})ertrophied,^l)rescnting a convex outline wln'ch is very characteristic, whilst the biceps is atrophied. In the hand and fdicaiin the muscles usually escape, but the extensors of the wrist and fingers are sometimes slightly enlarged, and the supinator longus may be atrophied or enlarged. The intrinsic muscles of the hand nearly always escape ; but examples of hy})ertrophy have been observed by Sachs, and enlargement of the abductor indicis by Dr. J. Taylor (Gl). The muscles of the face and neck are not affected as a rule, but in a few cases the tongue and masseters have been enlarged. The weakness of the muscles gives rise to a peculiar attitude and gait. While sitting down nothing peculiar is noticed ; but when the patient is told to stand u}), es})ecially from a low seat, he finds considerable difliculty in doing so. This is due in great measure to w^eakness of the extensors of the hips and of the knees. Also, in getting up from the supine position on the ground certain actions are performed which are quite characteiistic. Instead of assuming the sitting position, the patient rotates the whole trunk ])y means of pressure with the arms on the
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