582 THE TREATMENT OF DISEASES. 



limbs in cold water, to standing or sitting in a draught when hot, or to exposure to 

 inclement weather. Particular sets of muscles which are of necessity in long 

 continued action in persons following certain mechanical trades, as, for example, 

 masons, milliners, shoemakers, and smiths, are those which are most frequently 

 involved, and in these cases the wasting may be permanently limited to these parts. 

 It has occasionally happened that the disease has followed a severe blow on the 

 back, or some injury to the spine. Thus in the case of a boy of fifteen wasting of 

 the muscles of the trunk and upper limbs followed a playful blow with the fist of 

 one of his companions between the shoulders. In another instance the first 

 symptoms of wasting of the muscles of the ball of the thumb occurred six months 

 after the fall of a bale of cotton cloth on the nape of the neck. A curious case is 

 recorded of a gentleman aged fifty-four, who suffered what he considered a slight 

 injury. In jumping across a flower-bed for a wager, he came down heavily on 

 his heels, and then fell backwards on his head. He was stunned for a time, 

 but gradually recovered, and after some days' confinement to his bed appeared to be 

 quite well again. It was, however, soon perceived that a great change had taken 

 place in his habits. Having been extremely fond of manly sports and exercises 

 rowing, cricketing, riding, and the like he discontinued to take part in any of 

 these, although he continued to go every autumn to the Scotch moors for the 

 purpose of shooting grouse. Five years after the accident, whilst engaged in the 

 last-named sport, he perceived that his right leg had lost a part of its usual strength, 

 and from that time the ordinary symptoms of wasting palsy developed themselves. 



The symptoms generally come on very gradually. The tailor finds that he 

 cannot hold his needle, the shoemaker cannot thrust his awl, the mason fails to 

 wield his hammer, the gentleman experiences a difficulty in writing, in taking out 

 his pocket-handkerchief, or putting on his hat. Some such incident directs attention 

 to the affected limb, which is then discovered to be wasted and shrunken. In most 

 cases the change begins in the upper limbs, most frequently of all in the hand, in 

 the ball of the thumb especially, and in the ball of the right much oftener than in 

 that of the left thumb. Next to those of the hand, the muscles of the shoulders are 

 apt to be the earliest affected ; sometimes those of the neck and face ; less often some 

 of the muscles of the lower limbs are the first to suffer. There seems to be a kind 

 of caprice as regards the starting-point, but the muscles of which we have just been 

 speaking are those which are ordinarily most employed by working men a fact 

 in favour of the theory that the disorder is sometimes the result of over-work. As 

 the disease progresses the natural rounded contour of the limbs is replaced by an 

 unsightly flattening, the bones stand out with unnatural prominence, giving the 

 member the appearance of a skeleton clothed in skin. This may be carried to such 

 an extent that the hand looks more like a claw than anything else. When the 

 shoulder is affected the whole limb dangles powerlessly at the side. Sometimes, as 

 we have seen, the disease extends to other parts of the body, and when the face is 

 involved it is veiled, as it were, by an impenetrable mask, no emotion changes its 

 unvarying aspect, and the expression is always solemn, stolid, and immovable. 

 Sometimes the muscles of the mouth and cheeks waste away, and then the saliva 

 dribbles out over the lips. The complaint sometimes induces a change in the voice, 



