« ForrigeFortsæt »
larly, has a broken-down, granular appearance. Many of the large multipolar cells have entirely disappeared; others have lost their processes, and have a shrunken appearance. Sometimes, a group of cells may be entirely destroyed, while others close by are apparently healthy. The nerve fibrillæ disappear with the cells. The interstitial connective tissue increases; the bloodvessels are frequently dilated and surrounded by wide open spaces. There
is a distinct degeneration of the anterior root fibers as they pass through the anterior white columns to form the spinal roots. Some of these are entirely gone, others partially. (See A. C, and A. N. R. in Sections 2 and 3.)
In the pyramidal tracts, changes take place which are quite as distinct as those already mentioned. Both in the direct and the crossed pyramidal tracts, nerve fibers will be found in various stages of degeneration, some slightly affected, others entirely destroyed. (See C. P. T. and A. P. T. in Sections 2 and 3.) With this destruction of nerve tissue there is an increase in the growth of the connective supporting tissue. These two processes, one a failure of nutrition with a more or less complete destruction of nerve tissue, the other an increase in the normal nutritive processes of the supporting connective tissue, go on side by side until a condition of sclerosis is established.
These pathological changes may be more intense in one part of the cord than another. If the wasting and paralysis is more marked in the upper extremity than elsewhere in the body, the pathological changes in the cervical cord will be more intense than in sections lower down.
When the disease first shows itself in the lower limbs, and these are the seat of marked changes, the lumbar region of the cord will be found to have suffered more from the morbid process. The degenerative process may not confine itself definitely to the pyramidal tracts, but may extend out into the so-called mixed zone and affect fibers which probably connect cells at different levels of the cord. Fibers may also be found degenerated in the anterior lateral descending tract. It is important to remember in this connection that none of these tracts have a welldefined border, but that near the outside limits of any particular tract may be found fibers which do not functionally belong to
it, and which may not be affected by the morbid changes which characterize the disease.
Degenerative changes in the pyramidal tracts may not be confined to the cord alone, but may extend up through the motor decussation in the medulla, through the pons and crus, into the internal capsule, and in some cases even into the cortex of the brain. If the disease is complicated with bulbar paralysis, the motor nuclei in the medulla will present changes similar to those in the anterior horn of the cord.
The posterior root fibers, the posterior cornua of the gray matter, and the posterior columns of the cord are not af
fected by the morbid process.
C. and P. R. in Sections 1, 2, and 3.)
Pathology. The The oldest pathologist thought the disease was primarily located in the muscle or the sympathetic nerve. These theories need not concern us at the present time, as they are of interest only as a part of the early history of the pathology of this disease.
The constant degenerative changes in the anterior horn of the gray matter of the spinal cord, especially in the multipolar cells and the anterior nerve root, the similar symptoms in acute diseases of the same parts, leave little doubt as to the relation between these pathological changes and the muscular wastings and paralysis so conspicuous during life.
It is a well-established fact that the in
tegrity of the motor cell in the anterior cornua of gray matter of the cord, is essential to the healthy nutrition and the proper function of the motor nerve arising from it, and the muscle which it controls.
Now when the nutrition of the motor cells fails, or is in any way interfered with, as it is in the disease under consideration, the nutrition of muscle and nerve is likewise changed, and consequently their function is interfered with, as is manifested in the paralysis and wasting of the muscles. If these changes in the motor nerve cell and fibers are slow, changes in the muscle are likewise slow, and wasting and paralysis proceed hand in hand. We are thus able to understand the slow failure of electrical excitability, as nerve and muscle degenerate together. If the course of the slow degenerative action be varied by a more acute process, or if the original process itself be somewhat rapid, nerve cell and fiber are damaged more rapidly than muscle, and we have paralysis in excess of wasting with an excess of voltaic irritability over faradic.
This slow decay and degeneration of the lower segment of the motor tract is the essential lesion of the disease; the lesion upon which the conspicuous symptoms of wasting and paralysis are dependent and to which they are secondary. But while the lower segment of the motor path is the seat of essential pathological changes, it is by no means the only part of the motor path affected by the morbid process. We have already seen that the pyramidal tracts are frequently degenerated, and that this degeneration in severe cases may extend upward through the various parts of the motor path, and even involve the cortex of the brain. Thus the upper segment of the motor path is involved as well as the lower, a fact which has not been recognized by many recent writers.
In the presence of complete degeneration of the lower segment, all symptoms which might arise from a disease of the upper segment by itself are lost. The loss of power that it would produce is. also produced by degeneration of the lower segment; a degeneration of the lower segment abolishes myotatic irritability, excess of which is characteristic of the disease in the upper segment. Hence, during life there is nothing to indicate a degeneration of the pyramidal fibers
relating to the muscles suffering from the atonic atrophy.
Sections 1, 2, and 3 represent transverse sections from the cervical, dorsal, and lumbar regions of the spinal cord in a case of atonic muscular atrophy. In these sections, especially 2 and 3, there will be noticed a decided degeneration of the crossed pyramidal tracts; yet during life there was nothing in the symptoms that would indicate any disease of the pyramidal tracts. The muscles of the legs, instead of being rigid with increased myotatic irritability (symptoms referable to disease of the upper segment), were atrophied, soft, and wasted, with the reflexes entirely abolished. Thus, while the pyramidal tracts are, in nearly every case, the seat of disease, there is not in the atonic wasting and paralysis. of the muscles an indication that they are affected.
Charcot has described, under a separate head of amyotrophic lateral sclerosis, a class of cases rather large in number, in which there is paralysis and wasting of the muscles of the upper extremities, with paralysis and excessive myotatic irritability of the muscles of the lower extremities. In these cases the seat of pathological changes is usually in the cervical region of the cord. The condition of the lower limbs is explained by the degeneration of the pyramidal fibers of the legs, the lower segment being unaffected, while the wasting and paralysis of the upper extremities is accounted for by the disease affecting the lower segment of the motor path. It is easy to understand how multiform varieties may arise from the affection of one part of the motor path and the escape of the other, or an unequal affection of both.
The separation of this class of cases under the head of amyotrophic lateral selerosis, by some writers, especially Charcot, carries with it the idea that the changes in the pyramidal tract are the primary and essential lesion, and that the morbid changes in multipolar cells and anterior nerve roots are secondary to the changes in the upper segment. The necessity of the separate classification from a pathological standpoint seems doubtful when we consider that the pyramidal tracts are degenerated constantly, or at all events with very few exceptions, in all cases of progressive muscular atrophy.
Whether there is any indication of this during life or not, depends on the relative changes in the two parts of the motor path. If the changes in the pyramidal tracts are excessive, while those in corresponding motor cell and nerve root are slight at any particular time in the history of the case, there may be symptoms pointing to a disease of the former. On the other hand, if the changes in the lower segment are greater than those in the upper, there will be no indications during life, so far as symptoms are concerned, that would point to any trouble in the upper. Then, again, we have no evidences in these cases under consideration that the changes in the pyramidal tracts are primary to, and the cause of, degeneration of motor cell and fiber in the lower segment. We have illustrations in our every-day experience, in cases of lateral sclerosis and dorsal myelitis, where there is a sclerosis of the pyramidal tract without any wasting of the lower limbs, and such a degeneration as is well known does not excite a complete degeneration of the lower segment which is the cause of atonic atrophy. On the other hand, it is doubtful if the disease in the anterior horn of gray matter is primary to the degeneration in pyramidal tracts. In poliomyelitis the anterior horn may be almost entirely destroyed, and yet it is not followed by any ascending degeneration of the related pyramidal fibers. Moreover, sections of the pyramidal fibers are not followed by any ascending degeneration.
Again, when sections are made through the spinal cord at different levels, in cases where the disease has been more marked in one part of the body than another, it will be found that the degeneration of the pyramidal tracts and anterior horns of gray matter go hand in hand; that where we find a marked degeneration of the one, we find an equal change in the other. This is shown in Sections 1, 2, and 3. In Sections 2 and 3 the degenerative changes are about equal, and well marked in the pyramidal tracts and anterior horn of gray matter and motor roots. In Section 1 the degenerative the degenerative changes are not so extreme, but are about equal in gray matter and pyramidal tracts.
It would appear, from the foregoing, that changes in both the upper and the lower segment of the motor path occur simultaneously, or nearly so; that changes
are not the cause or the consequence of changes in the other; that the separation of these cases, with atrophy and paralysis of the upper extremities, and paralysis with increased myotatic irritability of the lower extremities (socalled amyotrophic lateral sclerosis), into a class by themselves as a distinct and separate disease, seems uncalled for, at least from a pathological standpoint, and, as has been aptly put by one writer, is simply. "giving a new name to an old disease."
The nature of morbid processes is that of a degeneration, a failure of the nutrition of the nerve elements with an increase in the connective supporting tissue. When the changes in tissue are rapid, the process probably approaches an inflammation of a chronic form, but the nature of the process in the main is at the degenerative extremity of pathological changes.
(To be continued.)
THE UTILITY OF ANTHROPOMETRY.
BY DR. HENRY CLARK.
IF some one should ask, What is the utility of anthropometry? what is to be obtained from the values learned? he might be answered, The measurements compared together show (in case of the man measured) which of his dimensions have changed from time to time; and with a knowledge of the meaning of these changes, they show whether his progress toward health has been retarded or advanced. In case of a comparison between the dimensions of two men, it can be discovered (so far as dimensions have a meaning) which of the two is a better man, and in what his superiority consists; and in a series of measurements, it can be seen which man is making better progress toward a good condition, as well as in what lines any progress has been made. It may be interesting to illustrate these notions by actual examples.
A subject (case 1) has been rapidly and rather hopelessly growing fat. He wants to know how great the increase has been within a period of twenty days. Now the scales readily declare how much more he weighs than on the first date. It can be found in this way that he is heavier, too, than at an examination previously made. So much is known.
matter of fact, however, there has been very little increase in his weight recently, and this he knows; yet he is anxious to learn whether his condition is as good. Now this, if we admit that symmetry is a sign of condition, is a matter easy to learn by the aid of the tapeline. For if, after measuring the man, we compare all dimensions with each other, like for like, we find that the dimensions show an excess of value toward symmetry; hence we may judge the man, although he continues to gain fat (or does not become thinner), to be a very good man, despite his extra fat. Should it be found, however, that girth of any region is increased in such a way as unduly or disproportionately to have increased that region, then it may be questioned whether the man should pay any attention to such extra development, as indicating deterioration or running down.
As I suppose there is considerable interest in this phase of development, I may cite some figures, to be referred to for illustration, endeavoring to make such an explanation of their meaning as will be understood. Suppose the subjoined results to have been reached, as shown by measurements twenty days apart, expressed in inches :
We find on carefully comparing these figures, an increase in thigh and biceps; a decrease in forearm and waist; and a value about equal in chest measure.
Attention may be called to one or two apparent discrepancies in the foregoing figures, which are rather interesting as illustrating some unexpected variations. I refer to the large variations in values representing thigh girth, the measurement increasing1⁄2 inch, and the neck girth decreasing 3 inch. These are accounted for by the changes in the business occupation of the subject, accentuating the thigh movement - walking up stairswhich shows its effect on the girth of the limb at the region measured. This man had such a constitution that the effect of a change in his limb movements was
manifested even in the girth of the limb, and in so rude a test as that of the tapeline, in a distinct and appreciable manner.
It is in this way that the tapeline detects tendencies of certain occupations or pursuits in the marks they leave upon the body. I doubt not that moral motives leave equally plain marks upon us, which, if not eradicated, and if persisted in, change and transform the man, according to the persistency of the subject in certain lines of thought and activity, for better or for worse, and remain, perhaps, through generations of such as live in the ways of their ancestors.
A curious example or two are recollected by the writer, where a peculiar personal affliction so wrought upon a subject as visibly to affect his proportions. I shall refrain from quoting either case, but can well recollect in one the pitiful evidence of his grief in his varied proportions.
It is well known that the girth of the neck varies in favor of a larger girth in good condition than when the subject is sick. Girth of neck, too, is a tell-tale of condition when compared with girth of calf, both girths being often alike in good When the neck girth exceeds the girth of the calf, it may be guessed that the upper part of the body is too large.
I recollect a person who was presumed to be paralytic, in whom, having occasion to apply the tapeline for investigation, I found one leg girth smaller than the other. As this was the suspected limb, it might have been inferred that this deficiency showed some evidence of the paralysis. But the arm on the same side being measured, it was seen that this arm was smaller than the other, giving rise to a query whether the size of both limbs might not naturally be smaller in his case. These examples show plain results.
The investigations which ought in every growing boy to be often made, should teach one who knows how to read what indications are met, something of his tendencies, habits, and employments, so that when learned, the best means be taken for his growth aright, in heart, habits, and intellectual training, as well as in muscle and nerve. That he grows well, the tapeline will show the intelligent observer who knows what to look for and how to read indications of conditions or make-up.
An example for illustration may prove interesting. G. (case 2) is a well-nourished, average lad. His dimensions were noted two years ago. Recently, the accompanying values were obtained, which by comparison, elicit the ensuing deductions:
Age, Oct. 23, 1890, 14; Feb. 16, 1892, 16. Increase in age, one year and four months. Increase in weight, 194 lbs. Increase in stature, 3 in.; neck, 1%; chest, 5%; waist, 34; bicep, approximate increase in right, 15%; in left, 134.
This short extract from considerably full notes on this subject elicits the remarks which follow:
He is now an average boy of his age in development, but slightly tending toward less rather than larger size. His pulsation is not very strong; his chances for growth, therefore, are only average, since it is presumed that he uses most of his energy daily.
serving and comparing his condition at the present time with what he was at first. Both things should be considered in forming our judgment in the case.
We see, then, in so far as anything is to be learned in a hasty glance at this subject of anthropometry, that a judicious examination of the man can be supplemented and so certified in some particulars by the evidence which a tapeline supplies. We already know, after weighing a man, what he has gained or lost in weight, but we desire to learn just where the changes have been going on since our last examination. By applying a tapeline, we can see whether any part of the man has been too much exercised, or where a limb has grown, as well as how much any part of the man has failed of its normal nourishment. Then what changes are desirable as regards exercise and diet can be intelligently prescribed. I advised my patient (case 1) to cease eating an excess of fattening foods, while I could assure him he had lost nothing in efficiency or energy. The second man (case 2) I recommended to continue exercise in a general way. Both learned something by what was revealed by the tapeline.
Taking these dimensions in their order, and calculating roughly each one regarding its proportion to stature, we have, in the first place, the ratio of weight to stature, 1.72; in the second, 1.93; showing (by subtraction) a relative thickening up of the boy, equivalent to .21 of his stature. His proportion of neck to stature, from .19 became in the later measurement .203, showing a larger propor- DIET IN CERTAIN DISEASES OF THE KIDNEYS,
tionate neck than before. His "chest natural" shows, in like manner, a proportion of increase from ratio of chest to stature, .43 to .51, or .08 increase proportionally. His waist increase is .03 of his stature. In the right bicep, a variation in favor of the later dimensions amounts to .02; in the left bicep, to .02. A singular variation in the left bicep is noted, which value, contrary to what is generally expected, is larger than the right, while this unusual variation persists in the later measurements. His left bicep is, right along, larger than his right. The boy therefore, in the gain of nineteen pounds, shows the greatest increase of all in chest, waist, biceps, thigh, and calf, in the order mentioned, thus evidencing an excess of development lying largely in the chest, or at least in the upper part of the body.
Whether this sort of development is good is shown in two ways: First, by knowing whether his development corresponds in proportion with that of healthy boys of his age; and, secondly, by ob
STOMACH, AND LUNGS.
BY PAUL PAQUIN, M. D.
DUJARDIN-BEAUMETZ, while not an exclusive vegetarian, is one of the strongest supporters of vegetarianism from a physiological and therapeutic standpoint. No scientist has done more to prove the value of vegetarianism than he in the treatment of disease, or to indicate its hygienic scope in health. As in all reforms, many of its advocates have gone to the extreme, and radically banished all animal foods from their diet or the diet of their patients in all circumstances. On the other hand, while considering that vegetarianism is right physiologically, many of them refuse to admit that it is rational even as a means of treatment in certain maladies.
The writer, having studied the diet question for some time, both in the laboratory and in practice, has come to conclusions that sustain the vegetarian theory in most if not all conditions in health,