MYOPATHY 163 



and succeeds for a time in "maintaining the outward 

 appearance or semblance of healthy muscle." Deprived, 

 however, of its raison d'etre, and no longer able to assume 

 the functional role of true muscular tissue, this structural 

 substitute succumbs in turn from inertia and disuse, leav- 

 ing scarcely a trace behind, which constitutes the second 

 and final stage or degree. 



By thus regarding the sequence and nature of the 

 pathological events which lead up to and are concerned 

 in producing the diseased condition known as myopathy, 

 and which constitute and characterise its two degrees, we 

 persuade ourselves that we obtain a clearer insight into 

 the " manner and method" of the working of the various 

 factors responsible for its production, and alas! we also 

 realise the limitations of the curative powers of therapeutic 

 agencies and the futility of the most skilful efforts of 

 manual and electrical assistance. Nevertheless, we per- 

 ceive that however this diseased process is brought about, 

 remedial measures, to be even to a limited degree success- 

 ful, must be applied simultaneously with the commence- 

 ment of the shutting off of the nervine nutrient protoplasm 

 from the recipient muscular fibre discs, or before the 

 involved muscular structures have undergone degenerative 

 change beyond the hope of recovery, or while there is 

 still the possibility of renewing the continuity of neuro- 

 muscular tone and contractility with full voluntary func- 

 tional subserviency and potentiality. 



In relationship to what is claimed for myopathy in 

 connection with failure or non-degeneration of the more 

 proximal, as well as distal, nerve elements connecting the 

 affected musculature with the central nervous system, we 

 would remark that that claim gives good ground for 

 retaining a hope that it may still, after all, be possible to 

 devise remedial measures, which will suffice to renew that 

 material and functional connection of the divorced nerva- 

 ture and musculature w r hich disease, histological accident, 

 or failure has brought about, and that these measures are 

 most likely to be discovered along the lines indicated by 

 the local and general histological and physiological struc- 

 tural connections and continuities. 



We would further remark, regarding the general subject 



