. A treatise on the nervous diseases of children, for physicians and students. hattime at least six different formsof progressive muscular wast-ing have been described, andthe attempt has been made ineach case to prove the relationof the special form, either tothe Aran-Duchenne type, or tothe type of muscular pseudo-hypertrophy. The Aran-Du-chenne type has become thechief exponent of progressiveamyotrophies ; while muscularpseudo-hypertrophy has beenconsidered the most pro-nounced form of primary myo-pathies. The various types ofprogressive muscular diseasehave been established very largely in
. A treatise on the nervous diseases of children, for physicians and students. hattime at least six different formsof progressive muscular wast-ing have been described, andthe attempt has been made ineach case to prove the relationof the special form, either tothe Aran-Duchenne type, or tothe type of muscular pseudo-hypertrophy. The Aran-Du-chenne type has become thechief exponent of progressiveamyotrophies ; while muscularpseudo-hypertrophy has beenconsidered the most pro-nounced form of primary myo-pathies. The various types ofprogressive muscular diseasehave been established very largely in accordance withthe mere topographical distribution of atrophy or hyper-trophy. Though convenient for clinical designation, sucha distinction is not sufficient for a rational classificationof these various diseases. It must be our aim to find thecardinal symptoms which will help us to differentiate atonce, and easily, between those cases of progressive mus-cular disease due to spinal-cord lesions and those primarydystrophies, which represent a disease of the Myopathy Fig. 83—A Diagram designed to showthe Site of the Morbid Lesion in theSeveral Groups of Progressive Mus-cular Atrophy. 354 THE NERVOUS DISEASES OF CHILDREN. The following are the cardinal symptoms present in the majority of casesbelonging to the two large groups of cases : Progressive Amyotrophies. Progressive Myopathies. Onset late in life ; rarely in early Onset in early life. childhood. Not hereditary, as a rule. Generally hereditary (family trouble). Wasting first in the upper extremi- Wasting or hypertrophy begins in ties (leg type rare). the lower extremities. Hypertrophy does not occur. Hypertrophy frequent. Fibrillary twitchings. No fibrillary twitchings. Reaction of degeneration often pres- Reaction of degeneration rare (quan- ent in affected muscles. titative, not qualitative, electrical changes). These points of differential diagnosis will hold good in the majority of , Ho
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