A handbook of the theory and practice of medicine / by Frederick T. Roberts.

  • Frederick Thomas Roberts
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: A handbook of the theory and practice of medicine / by Frederick T. Roberts. Source: Wellcome Collection.

    946/1006 (page 926)
    atrophied, the nerve-elements being replaced by a finely-granular tissue. The morbid changes in the cord are ])ractically limited to the anterior cornua. The nerve-cells are found in all stages of atrophy and degenera- tion ; and in some instances this change is simple. In others dilatation and thickening of the blood-vessels have been noticed; and in some cases compound granule corpuscles and oil-globules have been present. The anterior columns and adjacent parts of the cord sometimes exhibit distinct sclerotic characters. Symptoms.—Wasting palsy sets in very insidiously. It usually begins in either shoulder or hand, especially the right, but gradually advances from its starting-point so as to invade other muscles, until finally every voluntary muscle in the body may be involved, except those of the eye- balls and eyelids, and the muscles of mastication. Exceptionally the muscles of the neck, trunk, legs, or face are first implicated. The atrophy seems to begin most frequently in the right hand, involving the thenar eminence, then the hypothenar, and then the interossei. The right deltoid is not uncommonly first affected. There is failure of muscular power, corresponding in situation, extent, and degree to the wasting, and this may culminate in absolute helplessness, with inability to swallow, speak, or breathe, death then resulting from asphyxia. At the same time there are marked objective signs of the atrophy of the muscles, which are well seen about the shoulders and in the hands, the latter assuming the claw- hand shape, or main en griffe characterized by deep depressions due to the wasting of the muscles, while the tendons stand out, and the fingers are drawn in towards the palm, being also pushed back; the ball of the thumb is much wasted; the shoulder is flattened or depressed; and the bony prominences seem to stand out. The claw-hand is due, as shown by Duchenne, to the special paralysis of the interossei and lumbricales, the extensors and flexors still retaining their power, at least partiaUy. The tissues have a soft and flabby feel. The face assumes a vacant or idiotic expression when its muscles become affected. During the progress of the wasting the muscles present constant flickering or fibrillar movements, so long as any muscular tissue is left, which are more marked if the skin is exposed to cold or blown upon. The irritabiHty and force of contraction under electricity become diminished in proportion to the waste of tissue, but there is no reaction of degeneration. The reflexes may be exaggerated at an early period of the disease, but soon become diminished, and are finally abolished. The temperature of the affected parts is reduced, and the patient is usually very sensitive to cold. The mind is unaflfected to the last. Pains are not uncommon in the diseased parts, either myalgic or articular. There is never any loss of power over the bladder or rectum; and the heart is never implicated. Sexual functions are not involved; and there are no trophic skin-lesions. In some cases wasting palsy does not spread to the extent above described, but is arrested in its progress, the patient ultimately recovering, especially when it is due to fatigue of special muscles. Death generally results from extension of the disease to the medulla oblongata, when bulbar symptoms supervene; or to pulmonary complications, a slight bronchitis being very dangerous if the respiratory muscles are involved. Sometimes the fatal result arises from gradual exhaustion. The duration of wasting palsy is very variable. Diagnosis.—The conditions which are liable to be mistaken for pro- gressive muscular atrophy are paralysis from local injur)' or from disease of a nerve; amyotrophic lateral sclerosis ; chronic lead-poisoning ; polio-