WASTING I'' 583 



which loses its register, and is finally ivdu.vd to a monotone. In extreme cases 

 absolute immobility of the limbs or affected parts may result, but more commonly 

 the various mo vein able of being performed, though with greatly 



diminished force. Occasionally during the progress of the disease the wasted 

 muscles exhibit curious flickering or tivmulous movements, which can be seen going 

 on under tin- skin. They are not sufficiently powerful to move the limb, and they 

 commonly pass unnoticed by the patient himself. They afford a proof that the 

 muscle is not yet dead. In some cases the progress of the disease is accompanied 

 by a good deal of pain of a neuralgic character. In a few instances agonising pain 

 has been a marked feature of the case. The general health remains unaffected, the 

 intelligence is unimpaired, and the ordinary functions are usually performed with 

 their accustomed regularity. 



With the view of conveying a clearer idea of this terrible, though interesting 

 malady, we give an abstract of one of the earliest recorded cases. The patient was 

 a mountebank, aged thirty-two. From his own account it appears that one cold 

 September night he slept on the muddy pavement of the streets, and in the 

 morning on awaking found his right side quite benumbed. The warmth of a 

 tavern fire soon restored both sensation and motion, but three weeks afterwards he 

 noticed a weakness of the right hand, and from that time was no longer able to 

 play the cornet-a-piston. For a year the weakness was confined to the muscles of the 

 hand ; he then passed another night in the cold and wet, and from that time felt a 

 great weakness in his legs. This gradually progressed, and about a year later he 

 was so weak that he had to come to the hospital. At the time of admission he 

 could dress himself and walk, though with trouble, and could feed himself, and talk 

 without difficulty. Speaking of his own condition, he said, " I am not ill, but iny 

 strength is gone, and my weakness increases daily. There is a feeling of great 

 lassitude in my limbs, which torments me eveiy hour, but especially on awaking 

 from sleep." Still another year later and the unfortunate patient could na 

 walk at all, neither had he the power to change his position without help. His food 

 was given him, and he had to be put to bed just like a little child. His appetite 

 was voracious, but he had the greatest difficulty in swallowing, and twice he was 

 nearly choked by pieces of vegetable sticking in the throat. The only way to feed 

 him was to place a spoon containing food right at the back of the throat ; consider- 

 able efforts at swallowing on the spoon and its contents were then made, and the 

 former being withdrawn, the food was in time swallowed. The saliva could not be 

 got rid of, and constantly ran from the mouth. In trying to swallow liquids, 

 the greater part was always returned. The power of articulation being lost, 

 the wants were made known by nods, by the eyes, and by guttural, nasal sounds. 

 The respiration was very incomplete, so that it seemed certain that the unhappy 

 man, whose intelligence was unimpaired, was menaced every moment with suffoca- 

 tion. Finally he was seized with the then prevailing influenza, and being unable 

 to expectorate the phlegm, was one morning found quite dead. This, it must be 

 remembered, was an unusually severe case. 



The course of this disease is essentially chronic, and its duration uncertain. It 

 often happens that after destroying a group of muscles, its course is permanently 



