-MUSCULAR ATROPHY FOLLOWING NEURITIS.—A history of lead poisoning The anatomical relations between the re gion injured and the atrophied muscles usually render the diagnosis easy.
Priznary muscular dystrophy in two brothers. The parents were healthy. In both eases there 1% :IS slow onset in child hood; atrophy affecting the should( r girdle, upper arms, and thigh. Theo dore Diller (Med. Rce., Nov. 7, 'IM).
Pathology.—The disease is, according to Erb, a primary inyopathy, the cord and motor nerves showing, as a rule, no alter I .1" )1.4:1 11:1 i 11 11 e eel IS • • • hale been ObSerV0d, L L ' 1. .11 Ilk.t 11111 been connected •1 t .)opatl.y. The muscular fibres .1 - v arious stages of r,. me thing. atrophied, others tr •,.1..,t. 1. t may be present in • r.• • •a. comic( tive tissue and coll ....oil:, tl p,indohypertrophy alluded t. • irst eliangts. however, usually • III true hypertrophy of the mus o_ 11:.rts. follol‘eil by fissure and in ,. r ef while the connective ict nits grtatly increased in the r:pay,itun internum. The stage of thi n follows and progresses (..a-c of rogressive muscular dys trLid.y. in w hich there was found fatty arc in the middle of two degenerated u- ular sheaths: a fact not hitherto Iscr.cd. :11(inzer (Allge. med. cent. Z it., Aug. 26, '93).
Case representing a torm of precocious ..ti :totr hy of rapid course with pre .: n inating symptoms in the lower 1./_I s. and belonging, therefore, to the di- °Ise called by Hoilman "progressive =Final airj ()trophy of early infancy." "11,,- affection is characterized by the r.ii.1 tr,,phy of the muscles, the ,m-e ci adipose tissue. and a secondary 1 rdr-is oh muscular retraction. Fi brillary itchings may or play not be r..,-ef.t. Pathologically there is simple tr hy of the muscles, and th.r. r disanoarance of the cells of the .1 r cornua of the spinal cord and of t:,e ,nterior roots. The prognosis is r..ble, death usually occurring not ••er t an the sixth year. There are • rous transitional forms of the dis c P. II. ',halter (Revue de .1.10.. 10. .
111-te ries of 20 cases colleeted from • ...rds of the Philadelphia Orthopxdic
If piTal an.I Infirmary tor Nervous Dis s Most of the patient?, presented tl.e fcrm known as pseudohypertropby. F. ur 1 thP patients were of the female sex: all were white. Attention is call-d to the rarity of dystrophies in pure blacks. In I I of the eases in fectious diseases had preceded the on set. of the dystrophy. In only 2 cases did similar disease exist in another member of the same family. As to the pathogenesis of the disease, nothing is know 11. The hypothesis is suggested, how ever, that the disease may be con nected in some way with the thymus gland, as. its commencement usually falls in the period during which the thymus is normally most active, and the use of thymus extract is proposed in the treat ment of the dystrophies. A. „.k. Eshner (Amer. Jour. Med. Sci., Sept., '93).
Cases of muscular atrophy occur which liresent the well-known localizations re garded as characteristic of the different forms of muscular dystrophy. In the large majority of these cases the spinal cord and peripheral nerves are normal. In other rare cases presenting the clinical features of muscular dystrophy, the nerv ous system is more or less involved. The histological changes in the muscles are not pathognomonie of any form of atrophy. It is proper to regard muscu lar dystrophy as a disease usually dis tinct from spinal muscular atrophy, but transitional forms connected the myo pathic and myelopathic types of atrophy. W. G. Spiller (Med. Record, July 22, '99).
Treatment. — Muscular exercise is thought by Cowers to stay the progress of the disease. Electricity and massage carried out assiduously have also been recommended, but no treatment has so far brought about complete recovery. The general health should receive the greatest attention, tonics, nutritious food, fresh air, etc., by increasing the vigor of the organism, tend to delay the progress of the degenerative process. When the patient is bedridden, care should be taken that the contractures do not cause flexion of limbs in awkward positions.