Nervous and mental diseases . layers of wind-instruments and glass-blowers; to syphilis, toBrights disease, and other wasting maladies. It may be a part ofamyotrophic lateral sclerosis. It has appeared in tabes dorsalis, in-sular sclerosis, syringomyelia, and followed descending degeneration ofthe pyramidal tracts after cerebral lesions. Knowledge of the role oftoxemia in these chronic disturbances is widening. Progressive bul-bar palsy has been known to follow lead intoxication and diphthericpoisoning. Often the causation is entirely obscure. Morbid Anatomy.—The lesion is limited to the nucle
Nervous and mental diseases . layers of wind-instruments and glass-blowers; to syphilis, toBrights disease, and other wasting maladies. It may be a part ofamyotrophic lateral sclerosis. It has appeared in tabes dorsalis, in-sular sclerosis, syringomyelia, and followed descending degeneration ofthe pyramidal tracts after cerebral lesions. Knowledge of the role oftoxemia in these chronic disturbances is widening. Progressive bul-bar palsy has been known to follow lead intoxication and diphthericpoisoning. Often the causation is entirely obscure. Morbid Anatomy.—The lesion is limited to the nuclear cells in thelower half of the bulb. It is practically symmetrical. The hypo-glossal nucleus is most severely affected^ as a rule. The nuclei of thetrue spinal accessory, the facial, the motor portion of the trifacial, andthe pneumogastric are invaded with decreasing intensity and degenerative process is found in the nerve-trunks whose nuclei areaffected and their muscular terminations waste. The muscle-fibers. Fig. 63. -Case of bulbar palsy. 1, Photograph taken shortly before first symptoms were noted; 2, pho-tograph taken four years later, a few weeks before death. themselves show corresponding degeneration and atrophic minute anatomy is the same as that in progressive ophthalmoplegiaor that of progressive spinal muscular atrophy, to which the reader,bearing in mind the special location of this disease, is referred. Theorganic changes of associated atrophies and scleroses or of primary con-ditions, such as tabes, syringomyelia, insular sclerosis, and descendingcerebral degenerations are at times encountered. Symptoms.—The symptoms begin insidiously and progress tongue is usually the first aifected. This is manifest in a thick-ened pronunciation, particularly of the letters which require definitelingual movements. The linguodentals and linguopalatals (see table,p. 67) and the vowel ^^e^ and later on the explosive labial sounds arelos
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Keywords: ., bookcentury1900, booksubjectmentalillness, booksubjectnervoussys
