Muscular Atrophy Considered as a Symptom 251 



blended with it, forming a plate or plaque which is raised 

 somewhat from the fibers, but never encircles it. The axis 

 cylinder is distributed to this plaque, but does not penetrate 

 the interior of the fiber. The origin of the efferent or senso- 

 ry nerve fibers in the muscle is still a matter of uncertainty. 



Fatty infiltration and degeneration of the muscular fiber, as 

 occurring in the myopathic form of atrophy has been desig- 

 nated as myositis or lipomatosis. Here hj'perplasia of the in- 

 terstitial connective tissue and fatty infiltration follow closely 

 upon the wasting of the muscle, and cause either no apparent 

 change or else a slight increase in its volume. The muscle 

 appears pale, j^ellowish, has a greasy feel, and resembles 

 closely, not only macroscopically, but also microscopically, a 

 lipoma, or, better, a myo-lipoma. Under the microscope, the 

 large, round, yellowish cells, with dark borders, make up the 

 greater portion of the tissue. Here and there a muscular 

 fiber, with its transv^erse and longitudinal striation still intact 

 may be observed. (See Plate, fig. 3.) 



The interstitial connective tissue is much increased in vol- 

 ume, with proliferation of its nuclei. The substitution of fat 

 may be so pronounced as to give the muscle an hypertrophied 

 appearance, and hence the denomination pseudo-hypertrophy, 

 given this affection by Duchenne in 1861. In some forms of 

 dystrophia, the muscular fiber may be even increased in vol- 

 ume, giving rise to real hypertrophy, a condition sometimes 

 met with in idiopathic muscular atrophy. 



Myelopathic Atrophies, or Atrophies dependent npon Lesiotis 

 in the Spinal Cord. — They may be acute or chronic. The 

 acute forms are poliomyelitis acuta infantilis (infantile para- 

 lysis) and poliomyelitis acuta adultorum. Although not con- 

 clusively proven, still it is generally supposed that the onset 

 of this type of inflammation is due to some infection. Cases 

 are very common, both in the infantile and adult forms, where 

 an infectious disease preceded the attack. I have reported a 

 case occurring in a man forty-three years of age where the 

 poliomyelitis was undoubtedly the result of measles. 



The acute stage is ushered in by general malaise, headaches, 

 pains in the back and limbs, fever, rapid pulse, somnolence, 



