Muscular Atrophy Considered as a Symptom 239 



upon the stirrup will be registered upon the dial of the dyna- 

 mometer and the approximate strength of the extensors of 

 the leg can be ascertained. By lengthening the strap which 

 connects the dynamometer with the belt (a), and flex- 

 ing the foot on the leg as much as possible then allowing the 

 patient to push, the power of the extensors of the foot can be 

 also determined. In applj'ing the Pedo-dynamometer, the 

 thigh should be flexed upon the pelvis to an angle of 

 135 degrees, the leg flexed upon the thigh to an angle 

 of 90 degrees at the knee. It may be adjusted in the stand- 

 ing or recumbent position. Bj' using snaps the dynamometer 

 can be quickly removed and used to measure the power of the 

 hands. 



In advanced cases the patient is very susceptible to changes 

 of temperature, particularly from warm to cold, and in win- 

 ter the atrophied members must be heavily padded to insure 

 comfort. In those cases where rheumatic pains have pre- 

 ceded the atrophy, and also in those cases of neuritic and 

 spinal origin, there is some loss of sensation and other dis- 

 turbances, but in the great majority of cases the general 

 sensibility is unimpaired. 



As a rule, pain is absent in muscular wasting except in 

 cases of neuritic and spinal origin, and here the pain is a 

 neural pain and not a muscle pain. Pressure over the course 

 of the inflamed nerves or on the spine will call forth sharp, 

 shooting pains, whereas pressure applied to the muscle will 

 elicit no complaint. 



The objective signs offer the physician an important and 

 interesting field for study and observation. His attention, as 

 was that of his patient, is directed at once to the wasting or 

 atrophy of the different muscles. The natural effect of this 

 is to rob those portions of the body of their normal contour 

 and beauty, and bring into prominence the underlying hard 

 structures. This wasting may be limited to a single mus- 

 cle, to a group or system of muscles, maj^ be unilateral or 

 bilateral, general or localized, according to the cause and seat 

 of the primarj' lesion. In estimating the extent of the 

 atrophy, some more definite means are necessary than merely 

 the sight or touch — and the tape measure is called into service. 



