252 William Christopher Krauss 



delirum, convulsions, and in a short space of time a general 

 or partial paralysis sets in. After the decadence of the acute 

 stage, the paralysis confines itself to one, rarely several, of 

 the extremities. The muscles waste rapidly and show degen- 

 erative electrical reactions, the tendon reflexes are absent, 

 trophic changes are present, but no disorder of sensation. If 

 one of the legs be affected, the gait becomes very characteris- 

 tic owing to the atrophy and weakening of the peroneal 

 muscles. The patient is obliged to throw the foot far for- 

 ward, the toes striking the ground first. Charcot calls these 

 patients ' ' steppeurs. ' ' 



In the adult form the disease is not so liable to recede and 

 the affected members remain often permanently powerless. 



The chronic forms comprise most of the chronic affections 

 of the cord. They are divided by Charcot, according to the 

 seat of the lesion, into protopathic, where the lesions are 

 solely and alone in the gray matter ; and deuteropathic, where 

 the gray matter is only secondarily affected. Under the first 

 head we have the Duchenne-Aran, or hand type, character- 

 ized by wasting beginning in the small muscles of the hand, 

 as the interossei, superficial and deep muscles of the thenar 

 and hypothenar, then extending to the flexors and extensors 

 of the fingers, biceps, brachialis anticus, supinator longus, 

 pectoralis major, trapezius, infraspinatus, supraspinatus, 

 rhomboid, serratus magnus, latissimus dorsi and sometimes, 

 though rarely, the flexors and extensors of the hip. The ten- 

 don reflexes are absent, fibrillary twitchings and altered elec- 

 trical reactions are present There are no symptoms indica- 

 tive of trophic changes or disorders of sensation. This type 

 of atrophy is the original form of progressive muscular 

 atrophy described by Duchenne and Aran in 1848 and 1850. 



In 1886 there appeared simultaneously from Charcot and 

 Marie in France, and Tooth in England, the description of an- 

 other form of atrophy. Its mode of onset is by attacking the 

 muscles of the lower extremities, the extensors of the toes 

 and the small muscles of the feet. As a result there develops 

 a double club foot which is quite characteristic of this type. 

 The peronei, the calf muscles and later on the muscles of the 



