24 Dublin Journal of Medical Science, vol. xiv., August and Nov., 1852, p. 245.
It is possible that a case of progressive muscular atrophy might begin in almost any muscle or group of muscles in the body. In progressive muscular atrophy, however, the appearance of the skin is different; it is not mottled; it is not thin, as can be demonstrated by manipulation of it; it can be raised by the fingers; it is soft and flaccid. In progressive muscular atrophy also first one muscle and then another, just as likely as not at some distance from each other, are attacked by the wasting process; in unilateral facial atrophy the affection spreads uniformly and regularly over one-half of the face. According to Duchenne of Boulogne, when progressive muscular atrophy first appears in the face the orbicularis oris is the muscle most likely to be attacked, causing the lips to appear enlarged and pendent, and giving a stupid look to the patient. In unilateral facial atrophy this appearance is not present. Progressive muscular atrophy commonly begins at a later age than unilateral facial atrophy.
Hypertrophy of the opposite side of the face is suggested by Eulenburg as a possible source of mistake; but a little study, however, will suffice to exclude this affection.
The following points are given by Eulenburg with reference to vitiligo and porrigo decalvans: “In vitiligo we find the same white decoloration of the skin, the cicatricial feel, the turning gray and falling out of the hair, but not the loss of volume, which is the special characteristic of this disease. In porrigo decalvans inflammatory symptoms and œdema of the skin come first; the disease first appears in regular circular spots; the hairs fall out without previous loss of color; and finally, the disease is contagious, and fungi can be demonstrated (microsporon Audouini).”
PROGNOSIS.—The prognosis as to recovery is bad, but, as already shown, the disease may long remain stationary.
TREATMENT.—No well-authenticated case of cure under any method of treatment has yet been reported. Electricity, either in the form of galvanism or faradism, has been resorted to in a majority of cases. In most of these temporary benefit has been produced by the employment of these agencies. Baerensprung reports two cases as having been greatly benefited by faradism. In Moore's case it also produced temporary improvement. Carefully administered massage should be tried. With reference to friction or massage, however, it is well, as advised by Eulenburg, to be cautious, as excoriations are easily produced. Measures directed to building up the nervous centres are indicated—such medicinal agents, for instance, as the salts of silver, gold, zinc, and copper, arsenical preparations, strychnia, and iron.
DISEASES OF THE MEMBRANES OF THE BRAIN AND SPINAL CORD.
BY FRANCIS MINOT, M.D.