Muscular Atrophy Considered as a Symptom 245 



attempt need be made to treat the functional atrophies per se, 

 as in the great majority of cases they are passive, dependent 

 upon disorders of the system, which when relieved permit the 

 atrophies to disappear. 



Pathological atrophies are either atrophy of inaction, 

 (functio lesio) or trophoneurotic. The former can hardly be 

 classed as pathological, less physiological. They result when 

 the functional activity of the cells is interfered with, and the 

 nutritive changes are therefore diminished or abolished. As 

 a result the member grows smaller and weaker and continues 

 so until the cells regain their normal activity. Under this 

 head we meet atrophies due to anchyloses, surgical appliances, 

 hysterical contractures, etc. I have seen the arm reduced to 

 skin and bone in cases of hysterical contracture, and, although 

 the rest of the body was well nourished and developed, still 

 the unused extremity was in a state of extreme atrophy. It 

 is a simple matter to diagnose such muscular wasting because 

 it is local, the cause is so very apparent and symptoms 

 pointing to complication are generally absent. No patho- 

 logical lesion can be found except a diminution in the bulk of 

 the muscle fibers. The treatment of these cases is very satis- 

 factory . 



The tropho-neurotic atrophies are pathological and their 

 causes may be sought for in some disturbance along the course 

 of the peripheral nerves, spinal cord, brain or muscles. These 

 atrophies have a distinct and clearly definable pathology, and 

 are accompanied by symptoms indicative of an organic lesion 

 permitting of accurate diagnosis. 



Neuropathic Atrophies. — Inflammatory conditions of the 

 peripheral nerves are productive of muscular wasting along 

 the course of the nerves. This class of atrophies may be 

 termed neuritic or neuropathic. If the atrophy follows a neu- 

 ritis, as in acute simple neuritis, multiple neuritis, endemic 

 neuritis, hemiatrophia-facialis, or a neuritis consequent to 

 trauma, pressure, chemical or thermal irritation, or secondary 

 to some inflammation of a neighboring organ, it is always 

 accompanied by the general symptoms characteristic of nerve 

 inflammation. 



