PROGRESSIVE MUSCULAR ATROPHY. 



indistinct, and the tongue cannot pass food into the pharynx, even 

 after it has been placed in the mouth. Finally, after years of suf- 

 fering, the patients die, because at last the muscles of deglutition 

 and respiration also become atrophied, and fail to perform their 

 functions. Some intercurrent disease of the respiratory organs, in- 

 significant in itself perhaps, proves dangerous to the patient and 

 hastens his end, because, owing to the paralysis of the abdominal 

 muscles, he is unable to cough up the secretion collecting in the 

 bronchi. 



[In the last stages of some cases there is local anaesthesia ; and 

 sometimes there is contraction or faulty reaction of the pupil from 

 paralysis of the radial fibres of the iris. Besides the atrophy of the 

 muscles, there may be other trophic disturbances, such as atrophy of 

 the skin, herpes in the region of the affected nerves, and affections 

 of the joints and bones of the phalanges, carpus, etc. There may 

 be profuse sweating, and changes in the urine, especially diminution 

 of creatin (the product of muscular changes). Sometimes the tem- 

 perature of the affected limbs is at first higher ; later, it may be 

 several degrees below normal. 



Progressive muscular atrophy may be mistaken for what Char- 

 cot has recently described as sclerosis of the lateral cords (scl'e- 

 rose laterals amyotrophique) ; this sclerosis is most extensive in the 

 cervical medulla, but may extend up into the pyramids and pons or 

 down into the dorsal and lumbar regions. As the anterior horns 

 of the gray substance are implicated in the disease, and undergo the 

 same changes as in progressive muscular atrophy, the symptoms of 

 the two diseases are mingled. But there are other symptoms which 

 do not occur in progressive muscular atrophy ; there is a true para- 

 lysis and a subsequent atrophy of all the muscles of the limb af- 

 fected ; these are followed by spastic contractions, which it is said 

 do not occur from progressive muscular atrophy.] 



TREATMENT. In those forms of progressive muscular atrophy 

 resulting from overwork and limited to certain parts of the body, 

 the methodical use of the induced or constant current of electricity 

 and massage sometimes arrests the progress of the disease, and even 

 improves the nutrition of the emaciated muscles. But great pa- 

 tience and perseverance are requisite for the attainment of this end. 

 All remedies, even the methodical employment of electricity, have 

 proved inefficacious in the form of the disease which spreads from 

 muscle to muscle. 



