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FIG. I.-Cross section of normal muscle. FIG. II.-Simple degenerative atrophy of muscular fiber. FIG. III.- Fatty infiltration and degeneration of muscular fiber. FIG. IV. Destruction of antero-lateral group of ganglion cells of anterior cornua in grey matter of spinal cord. The ganglion cells to the left (antero-median) are intact, while the antero-lateral have been replaced by cicatricial tissue. (After Wm. C. Krauss.)
CONTRIBUTION TO THE STUDY OF PROGRESS
BY W. H. RILEY, M. D., BATTLE CREEK, MICH.
Complications. The most frequent
Course. As the name indicates, the
wasting in the upper extremities. In some
The uniform progress of the disease
Pathological Anatomy. - The patholog-
The wasting of the muscles is even
When studied microscopically, the ap-
1. There may be simply a narrowing
the muscles in this part of the body will, as a rule, be more wasted than others.
If sections of the nerve are made and
C. P. T., Crossed pyramidal tracts, showing some degeneration of motor fibers; D. P. T., Direct pyramidal tracts, with slight changes; A. C., Anterior cornua, broken and having a granular appearance, with absence of some motor cells; A. N. R., Anterior nerve root fibers degenerated; P. C., Posterior columns, healthy; P. R., Posterior root, healthy.
(See Fig. II, Frontispiece.) There may appear in the muscular fiber a longitudinal striation, which increases until the muscle has the appearance of a fasciculus of longitudinal connective tissue fibers.
2. Again, there appears within the primitive sheath of the fiber small granules, which take the place of the transverse striæ, flowing together, and increasing in size until they form distinct fatty globules at different points within the sheath of the fiber. In this way the muscular substance is completely degenerated into and replaced by fat. (See Fig. III, Frontispiece.) Occasionally muscular sheaths may be seen which contain a clear, transparent substance, with here and there a transverse stria, and scattered through it a few fatty granules. transparent substance is probably the result of a process quite different from fatty degeneration; it has been termed "vitreous degeneration."
An entire muscle may be completely destroyed by one or more of the above described processes, while adjacent to it may be muscles which are in no way affected. On the other hand, we may have scattered through a large number of muscles, fibers which are completely degenerated; while in the same fasciculus, and by their side, may be found perfectly healthy fibers. As the disease more frequently begins in the arms and shoulders,
examined, there will be found scattered through the section many degenerated fibers; these will be more numerous in the peripheral branches than in the nerve trunk, and especially those terminal branches which supply the muscles.
If these degenerated fibers are traced upward, they will be found to come only from the anterior spiral roots. In the anterior roots of the cord, the degeneration is even more marked than in the nerve trunk. In the nerve trunk the sensory fibers lying by the side of the motor fibers are not at all affected; but the anterior nerve roots, being made up entirely of motor fibers, are more completely affected.
An examination of the spinal cord shows the affected parts to be softer than normal; the white matter may be grey and translucent. If transverse sections are made, properly hardened and stained, and examined under a microscope, morbid changes will be found in the anterior cornua and in the anterior lateral columns. The anterior cornua do not take the stain as readily as they do in a healthy section, or as readily as the posterior cornua of the same section. The central part of the cornua, particu
SECTION NO. 2.- DORSAL CORD.
C. P. T., Crossed pyramidal tracts, markedly degenerated; A. P. T., Anterior pyramidal tracts; A. N. R., Showing absence of nerve root fibers: A. C., Anterior cornua. Absence of many motor nerve cells, broken-down, granular appearance; P. C., Posterior columns, having a healthy appearance; P. R., Posterior root, healthy.