164 PHYSIC 



of muscular atrophy as compared with the restricted 

 subject under discussion, myopathy, that the latter, from 

 the immediateness of its cause nerve terminal distribu- 

 tion should be more amenable to treatment than the 

 former, which is often due to central and distant structural 

 changes altogether beyond the possible reach of the best 

 devised remedial and even ameliorative measures. 



It need scarcely be added that the occurrence of muscular 

 failure in all its varieties is a concrete subject of a most 

 far-reaching character, and one which, next to mental 

 sanity, is of the greatest importance to the individual and 

 to the world at large, inasmuch as the power of self- 

 support of the individual and the united individual con- 

 tributions to the coffers of the commonwealth are alike 

 at stake, and affected by it, hence its interest becomes a 

 matter of the greatest moment to the medical profession, 

 as well as the administrators of the State. That muscular 

 failure is usually, primarily, due to nerve failure, may be 

 regarded as axiomatic, except in those rare cases where 

 failure of muscular power is due to intrinsic failure of the 

 purely muscular structure elements, apart from failure of 

 any of the nervine structural elements with which the 

 affected muscle textures are supplied. Hence, we must 

 almost always be prepared to search for and to find, if 

 haply we can, the cause of the muscular breakdown in 

 some part of the nerve textures joining the affected muscu- 

 lature with its affiliated central nervature, i.e., in either 

 the parent nerve cell, its axonal process, or its terminal 

 nerve-plate extension, as in the case of the disease under 

 discussion, myopathy and muscular paralysis. In all forms 

 of muscular failure, irrespective of the locale of the original 

 breakdown, it is thus essential to recognise the universally 

 underlying fact that that failure is primarily due, except 

 in the rare cases of intrinsic muscle failure, to non-delivery 

 of the nervine nutritional protoplasm from failure of the 

 nervine vehicular agencies or nerve capillary circulatory 

 media to supply the muscle discs of the implicated muscle 

 fibrature. All this, therefore, is a matter entirely belong- 

 ing to the economy of the nervine circulation, as connected 

 with the nutritional phenomena involved in the growth 

 and maintenance of the sarcous elements of muscular 



