Muscular Atrophy Considered as a Symptom 241 



My manner of using the tape is as follows : For the upper 

 arm, I select the internal condyle of the humerus as the 

 fixed point. Then measure off seven and one-half centi- 

 meters with tape No. 2. At this point the circumference of 

 the arm is taken by means of tape No. i. In like manner the 

 circumference of the arm is noted at distances of fifteen, and 

 twenty-two and one-half centimeters from the fixed point. 

 For the lower arm exactly the same procedure is followed be- 

 ginning at the proximal end and taking the circumference at 

 seven and one-half, fifteen, and twenty-two and one-half centi- 

 meters from the internal condyle. For the hand a distance of 

 ten centimeters is measured from the tip of the middle finger 

 and the circumference taken at this point. 



For measuring the circumference of the leg, I employ the 

 internal condyle of the femur as the fixed point and take 

 measurements at seven and one-half, fifteen, twenty-two and 

 one-half, and thirty centimeters respectively from the internal 

 condyle. In taking the circumference of the abdomen or 

 thorax I choose the umbilicus as the fixed point. 



The atrophy of muscular fibers and the hyperplasia of the 

 connective tissue lead to contraction of the latter, and perma- 

 nent contractions and distortions of the body and extremities 

 result ; the same is produced if a system of muscles becomes 

 afi"ected and the opponents, remaining intact, predominate. 

 The peculiar shape of the hand in the Duchenne-Aran type, 

 sometimes called " main en griffe," the " turkey gait " in the 

 myopathic forms, etc., are examples of this kind. 



The integument of the atrophied members has a shrivelled, 

 purplish appearance, and the finger nails lose their pinkish 

 tint. Other trophic disturbances, except in atrophies due to 

 a neuritis, are wanting. 



In many cases a fibrillary contraction, wave-like in appear- 

 ance, propogated in the direction of the fibers may be ob- 

 served occurring either spontaneously or by gently tapping 

 the muscle. This fibrillation, as it is termed, is of short 

 duration, returns after an interval of a few seconds, may be 

 limited to a muscle, or part of a muscle, or may extend over 

 the whole of the affected part or member. It is not pathog- 



