Muscular Atrophy Considered as a Symptom 255 



Secondly, those forms of myopathy due to a chronic anterior 

 poliomyelitis such as the Duchenne-Aran or hand type and 

 perhaps the Charcot Tooth or peroneal type. 



The deuteropathic form comprises those affections in which 

 the involvement of the gray matter of the cord is secondary. The 

 atrophy following may be quite pronounced as in amyotrophic 

 lateral sclerosis, syringomyelia, and bulbar paralysis. A care- 

 ful examination is necessary at times to distinguish between 

 the atrophy of these affections and progressive muscular atro- 

 phy ; especially is this true of amyotrophic lateral sclerosis 

 and syringomyelia. These affections stand in close relation 

 to progressive muscular atrophy clinically and pathologically ; 

 nevertheless they can be diagnosed by sjmiptoms which are 

 more or less pathognomonic. In amyotrophic lateral sclerosis 

 the atrophy affects the muscles of the hand, arm, shoulder 

 and back simulating closely the Duchenne-Aran type of mus- 

 cular atroph3^ In exceptional cases the lower limbs become 

 implicated. Contractures develop especially in the terminal 

 stage. The tendon reflexes are markedly exaggerated, loco- 

 motion is difficult and, what is very characteristic, the disease 

 runs its course in two to three years. In regard to the dura- 

 tion and course of progressive muscular atrophy and amyo- 

 trophic lateral sclerosis there is difference enough to convince 

 any observer that the two affections are distinct from each 

 other. In regard to syringomyelia, although the atrophy re- 

 sembles the distribution in the Duchenne-Aran type, still it is 

 not so uniformly advanced on both sides, and the sensory and 

 trophic disturbances which are always present enable one to 

 make a differential diagnosis. In bulbar paralysis the focal 

 lesion is of the same general character as in progressive mus- 

 cular atrophy, but limited to the ganglion cells in the medulla 

 and pons. Atrophy of the parts innervated by the cranial 

 nerves will be the result ; in rare cases this process may ex- 

 tend caudad affecting the ganglia of the spinal nerves. 



In locomotor ataxia, multiple sclerosis, neoplasms of the 



cord, diff"use myelitis and myelo-myelitis, the atrophy is less 



pronounced, inconstant, and variable in its seat and intensity. 



Lastly, cerebropathic atrophies, generally observed in the 



