Muscular Atrophy Considered as a Symptom 237 



able to any direct appreciable lesion and the atrophy is con- 

 sidered as active. Another class, bordering closely upon physi- 

 ological atrophies, is caused b}^ derangements in whole or in 

 part of the constructive organs, febrile processes, etc. These 

 latter are considered as passive, and the atroph}' is unlimited 

 in its extent. Local atrophies, due to mechanical hindrances, 

 injury to the tissues, through interference of the circulation, 

 and overwork are also examples of passive atrophies. 



Pathological atrophies on the other hand, are the results of 

 demonstrable organic lesions either in the brain, cord, peri- 

 pheral nerves or muscles, follow certain laws in their distribu- 

 tion, and are accompanied by subjective and objective symp- 

 toms characteristic of the focal lesion. 



Subjective signs. — The advent of progressive muscular 

 atrophy in many cases, and especially in those other forms of 

 atrophy not dependent upon acute inflammatory processes, 

 is ushered in by some localized, deep-seated, aching pain, to 

 which little attention is paid. In others, some .slight sensory 

 disturbance, as a feeling of numbness, heaviness or sharp lan- 

 cinating pains as in neuritis, may precede the atrophy, while 

 in many no warning whatever is given of the enfeeblement 

 which is soon to occur. Generally, the first thing that attracts 

 the patient's attention is the inability to execute certain move- 

 ments, which, but a short time ago, he was able to carry out 

 with ease and dexterity. If he be an artisan, and the atrophy 

 begins in the muscles of the hand, as it so often does, the 

 weakness will soon incapacitate him for his work ; if a laborer 

 and the atrophy first affects the shoulder muscles, or muscles 

 of the back, or if a pedestrian and the peroneal muscles suc- 

 cumb early, he is soon made cognizant of some loss of power, 

 which to him remains for some time unaccountable. This 

 weakness is often a.scribed to overwork, exhaustion or fatigue, 

 and the usual remedy — rest — fails to restore to the former con- 

 dition. I have met patients in clinics, especially females, in 

 whom atrophy of the muscles of the hand and arm had existed 

 for years, and attention was first called to it by the physician 

 while examining for some other ailment. Instruments have 

 been devised for measuring approximately the strength of the 



