Muscular Atrophy Considered as a Symptom 249 



myopathic forms of muscular atrophy. It usually begins in 

 the muscles about the shoulder girdle, upper arm and back. 

 The pectoralis major and minor, biceps, brachialis anticus, 

 supinator longus, serratus magnus, rhomboidei, trapezius, 

 sacrolumbalis, latissimus dorsi and longissimus dorsi are the 

 muscles most often atrophied. The sterno-cleido mastoid, 

 levator anguli scapulae, coracobrachialis, teres, deltoid, 

 supra and infraspinati, rectus abdominis and the small 

 muscles of the hand remain undisturbed. The muscles of 

 the lower extremities which are at times affected are the 

 glutei, the quadriceps, the adductors, the peronei and the 

 tibialis anticus. The sartorius, gastrocnemius and soleus 

 remain as a rule unaffected. Occasionally hypertrophy of 

 some of the muscles is observed, notably the deltoid, in- 

 fraspinati, triceps, tensor fascii and muscles of the calf. 



This type of atrophy affects several members of the same 

 family, appears generally before the twentieth year, and has 

 a decided preference for females. It is not accompanied by 

 fibrillary twitchings, reaction of degeneration is not present, 

 and the tendon reflexes are unimpaired. 



Analogous to this type is the facio-scapulo-humeral type, 

 first described by Duchenne as the forme hereditaire ; but 

 later more fuller and minutely by Landouzy and Dejerine, in 

 1885. The wasting of some of the muscles of the face and 

 hypertrophy of the lips gives a peculiar tapir-mouth appear- 

 ance to the patient, ' ' facies myopathique. ' ' With this excep- 

 tion, this type of atrophy corresponds exactly with Erb's form, 

 and is regarded by many as one and the same. 



Another form is the pseudo-hypertrophic paralysis of Du- 

 chenne. Although hinted at years before by Bell, Meryon, 

 Oppenheimer and Partridge, it remained for Duchenne, in 

 1861, to interpret correctly its clinical importance and estab- 

 lish it firmly in our nosology. It is no doubt hereditary, and 

 occurs more frequently in boys than in girls. The important 

 symptoms are weakness in the muscles of the leg and back, a 

 waddling gait, an apparent increase in the size of the muscles of 

 tliecalf,and sometimes of the thigh and calf. Furthermore, there 

 is lumbar lordosis brought about by wasting of the muscles of 



