. A manual of diseases of the nervous system. ection of the muscles of theleg causes the early development of club-foot, which, especially inchildren, becomes a characteristic The arms are onlyinvaded, in most cases, some years after the legs, so slow is the courseof the disease. The intrinsic muscles of the hands (thenar, hypo-thenar, and interosseal muscles) are first attacked, and sxibsequentlythose of the forearm; sometimes the extensors and sometimes theflexors suffer first and most; while the supinator longus remainsnormal, and so do the muscles of the shoulder, neck, back, and
. A manual of diseases of the nervous system. ection of the muscles of theleg causes the early development of club-foot, which, especially inchildren, becomes a characteristic The arms are onlyinvaded, in most cases, some years after the legs, so slow is the courseof the disease. The intrinsic muscles of the hands (thenar, hypo-thenar, and interosseal muscles) are first attacked, and sxibsequentlythose of the forearm; sometimes the extensors and sometimes theflexors suffer first and most; while the supinator longus remainsnormal, and so do the muscles of the shoulder, neck, back, and atrophy is often symmetrical, but occasionally the muscles on oneside waste first and most. The claw-like deformity of the fingers mayresult from the affection of the intrinsic muscles of the hand. Thisis so rare in early life from any other cause, that its significance isconsiderable, a,nd almost distinctive when combined with the deformityof the feet just mentioned. The case shown in Fig. 162 was probablyan example of this type.|. Pia. 162.—Advanced muscnlai* atrophy, probably of the peroneal type.(Drawn by Dr. Spencer, from a photograph.) The affected muscles (especially in the hand) occasionally presentslight fibrillation. Their electric irritability is diminished sooner, and * Hoffmann, Arch. f. Psych., xx, p. 660; JoflProy, Gaz. Hebd., 1886, No. 18. t See Sachs, Brain, Winter part, 1889. % It was given in the last edition as an example of simple atrophy. The patientwas a man aged twenty-seven at the time of his death (in University CollegeHospital). No history of any analogous case in his family could be affection began at the age of fourteen, when his feet began to turn in so thathe walked on the outer side of the foot, and soon he noticed gradual wasting ofthe legs, which slowly progressed, and about the age of twenty-four the arms alsobegan to suffer. When first seen, a few months before his death, the muscularatrophy was universal, and the
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