60 Philada. Med. Times, 1871.
61 Loc. cit.
62 Med.-Chir. Trans., vol. xv., 1852.
63 Deutsches Archiv, Bd. xxii.
The sclerotic process which precedes the stage of fatty infiltration is far from being completed when this latter begins. Both processes, initiated nearly at the same time, continue together, and at the death of the patient may be found existing in about equal proportion, or the one markedly predominating over the other. In cases of long duration the hypertrophied muscles, as already stated, are found converted into masses of fat, divided by stripes and bands of connective tissue. With death earlier in the disease the enlargement is found to be due to masses of connective tissue englobing muscular fibres and interspersed with fat-cells.
In the wasted whitish-red muscles the proliferation of connective tissue is sometimes more, sometimes less, marked; in the pale-yellowish muscles fat accumulates by interstitial deposit, but does not overlay and conceal the remnant of muscular fibre.
Central Nervous Organs.—While the examinations of the diseased muscles have been frequent, post-mortem examinations are still relatively few, although their records are rapidly increasing. The first was made by Meryon64 on the first of his series of six cases. Charcot has examined a case for Duchenne; Cohnheim has made a celebrated autopsy for Eulenburg;65 Gowers and Clarke have together published a fourth.66 The cases by Müller and Barth are still habitually—though, as we shall see, erroneously—included among the autopsies of pseudo-hypertrophic paralysis. Ross67 and Leach have, however, a fifth indubitable case with autopsy; and more recently Cornil,68 Brieger,69 Bay,70 Schultze,71 Pekelharing,72 and possibly Goetz and Drummond,73 have all described post-mortem examinations. The data for discussion, therefore, are to be derived from 14 cases. Of these, the spinal cord was found perfectly healthy in 7, those related by Meryon, Cohnheim, Charcot, Cornil, Brieger, Bay, Schultze—all most competent observers. The cases by Barth and Müller require some special consideration, for, although rejected as irrelevant by most authors, Hammond still adduces them in proof of the central origin of pseudo-hypertrophic paralysis.
64 Loc. cit.
65 Loc. cit.
66 Med.-Chir. Trans., 1874; also monograph by Gowers.