Nervous and mental diseases . ^ig. 157.—A case of progressive muscular atrophy of the spinal type in the sixth year of thedisease. All skeletal muscles atfected. untary motion destroyed, and passive motion much limited. The mus-cles of the forearm suffer next, or they may escape for a time and theshoulder-muscles waste first. In other cases the muscles of the neckare first involved, and then those of the upper extremity, or the wastingmay even develop first in the legs or buttocks. Muscles like the pectoralis,deltoid, and trapezius, which have different associations, and receive theirinnervati
Nervous and mental diseases . ^ig. 157.—A case of progressive muscular atrophy of the spinal type in the sixth year of thedisease. All skeletal muscles atfected. untary motion destroyed, and passive motion much limited. The mus-cles of the forearm suffer next, or they may escape for a time and theshoulder-muscles waste first. In other cases the muscles of the neckare first involved, and then those of the upper extremity, or the wastingmay even develop first in the legs or buttocks. Muscles like the pectoralis,deltoid, and trapezius, which have different associations, and receive theirinnervation from different spinal levels, may waste in corresponding por-tions. It thus happens that the upper portion of the trapezius is fre-quently spared until late in the disease, as it is controlled by the spinal ac- 398 DISEASES OF THE COED PEOPEE. cessory. Again, it may suffer early. The muscles of the back are amongthose early invaded, and those of the scapula are commonly firstaffected, allowing corresponding displacements
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