. A treatise on nervous and mental diseases, for students and practitioners of medicine. so general is the atrophy, frequently commingled with true orpseudo-hypertrophy, as, in the remarkable case represented in and 131. This classification becomes additionally difficult at 238 NERVOUS DISEASES, the beginning of the disease in many cases, as in Fig. 132, where thesujDra-scapular atrophy belongs to no type. The course of the disease is gradual, and the duration is from fiveto thirty years. The chronic and fibrillary atrophy may uot bedetected for some time, until enough of the muscle h
. A treatise on nervous and mental diseases, for students and practitioners of medicine. so general is the atrophy, frequently commingled with true orpseudo-hypertrophy, as, in the remarkable case represented in and 131. This classification becomes additionally difficult at 238 NERVOUS DISEASES, the beginning of the disease in many cases, as in Fig. 132, where thesujDra-scapular atrophy belongs to no type. The course of the disease is gradual, and the duration is from fiveto thirty years. The chronic and fibrillary atrophy may uot bedetected for some time, until enough of the muscle has been affectedto alter the contour and consistence, which latter is then found,upon palpation, to be softer and less resilient than in a healthymuscle. The paralysis is usually proportionate to the atrophy, ashas been already stated. It not infrequently happens that the lossof muscular strength first attracts the attention of the patient, orthose interested in the patient, and then an examination brings theatrophy to view. Fibrillary contractions are frequently present in Fig. rhotograph of case ol supra-scapular progressive muscular atrophy. all the types. These consist of minute movements of the muscularfibres, and vary in extent from an occasional whipcord-like move-ment under the skin, likened by patients to a pulse-beat, to a wide-spread series of fibrillary movements that may set a whole muscle ormuscular group into tremulous movement. The electrical alterationsmay be those of the reaction of degeneration, or those of the so-called partial degeneration (pp. 110 and 111), or the electricalreactions may be normal. If the researches of Gessler upon themotor end-plates of lizards and guinea-pigs should be applicable SPINAL CORD AND MEDULLA OBLONGATA. 239 to human bfflngs, the reaction of degeneration will be in exactratio to the amount of atrophy of muscular fibre. Until within avery recent time it has been supposed that a spinal origin was indi-cated by the reaction
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