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and concisely; and perhaps the highest compliment that we can pay his Notes is, that they are interesting, instructive, and readable to the end. We trust that he may obtain all the credit to which his industry and perseverance entitle him.



An Essay on Wasting Palsy (Cruveilhier's Atrophy). By William ROBERTS, B.A.

M.D. Lond., Scholar of the University of London ; Physician to the Manchester Royal Infirmary, Fever Wards, and Lunatic Hospitals, &c. With Four Lithographic

Plates.London, 1858. pp. 210. We have at various times placed before our readers accounts of the investigations of different observers into the nature of the disease characterized by atrophy of one or more sets of muscles—a disease in which the primary changes seem to occur in the muscles, and one which in some respects resembles paralysis dependent on a lesion of the nervous centres. Without entering into a discussion as to priority of observation, it certainly does appear that Cruveilhier was the first correctly to interpret the phenomena ; he was disposed to regard the affection as dependent upon a disease of the spinal cord, until a post-mortem assured him that wide-spread muscular atrophy and paralysis could exist without any lesion of the nervous centres.* The first cases that he observed fell under his notice in 1832 and 1848; subsequently he met with two cases in which he found the anterior roots in a state of atrophy closely corresponding to the extent of the muscular degeneration occurring in each case. This

, however, as Dr. Roberts also justly remarks in the work before us, by no means proves that the primary fault was in the

On careful examination of all the evidence now at our command, there can be no doubt that there is a primary affection of the muscles, to which our author's term, or the designation of Cruveilhier or Aran, which is endorsed by Valentiner, Virchow, and others, may be applied.

The work of Dr. Roberts supplies us with a detailed history of this peculiar affection; the first chapter is devoted to this part of the subject; in the second chapter the general physiognomy of the disease is given, and we here meet with several cases which have fallen under the observation of the author, and which prove that his work is something more than a compilation. In the same chapter we find a careful analysis of no less than 105 cases which Dr. Roberts has collected from the records of the profession; this is extremely valuable to any one wishing to familiarize himself with the whole literature of the subject. The frequency of the complaint, its anatomical distribution and symptomatology, are the subject matter of the third chapter.

The disease presents two main forms; in the one the body generally is affected, yet without in reality implicating all the muscles, for there are a few which seem to be altogether exempt; the muscles of mastication and those of the eyeball, including the levator palpebræ, have not yet been known to be involved; still the disease invades the locomotive system so universally in many cases, as to justify the distinction of a general from a partial form, only a few muscles or sets of muscles being affected in the latter. Scarcely two instances are exactly alike in the combination of muscles implicated, and the relative degree in which they have suffered : hence an almost endless variety of feature. Yet in the partial form the disease shows a manifest predilection for the upper extremities; in 60 cases of this variety we find that, according to Dr. Roberts (p. 108), the upper extremities were exclusively affected forty-eight times. The chief symptom

The following are the references to the disorder in this Journal: Vol. vii., April, 1851, Aran on Progressive Muscular Atrophy; Vol. xvi., October, 1855, Valentiner, a Contribution to the Doctrine of so-called Paralysio Musculaire Progressive; Vol. xvii., April, 1856, Virchow on Progressive Muscular Atrophy; Vol. xviii., July, 1956, on Paralysis from Muscular Atrophy, by M. Cruveilhier. Dr. Meryon's paper on Granular and Fatty Degeneration of the Voluntary Muscles appeared in the Medico-Chirurgical Transactions, vol. xxxv., and is fully referred to in the Medico-Chirurgical Review, vol. ii.


of the disease is loss of motor power in one or more muscles, corresponding to the degree of atrophy affecting the muscle.

“The muscle goes on decaying slowly for months and years; its force declines at the same deliberate pace, so that it is only in extreme cases that any part is reduced to absolute immobility. The correspondency claimed between the bulk of the muscle and its contractile power is a distinctive feature of the disease, and serves to separate it in a marked manner from hemiplegia, paraplegia, facial paralysis, and indeed from any palsy depending on an injury to the cerebro-spinal centre or a nervous trunk.”


It is, however, undeniable

" that in certain instances this exact correspondence between the wasting of the muscles and the loss of power is departed from. The palsy sometimes overshoots the atrophy, and sudden variations of amendment or aggravation have been observed not at all consonant with our ideas of a defect dependent solely on an equably acting cause, such as muscular degeneration."

Next to the wasting and coincident loss of power in a group of muscles, the most prominent symptom is described by our author, and universally observed, as consisting in muscular vibrations, twitchings or tremors affecting individual muscular fasciculi

, which it appears may be set down as a diagnostic sign of the invasion of granular and fatty degeneration of the muscles. Great assistance in determining the diagnosis is afforded by Duchenne's method of local galvanization of the affected muscles. By applying the induced current to the individual muscles, and ascertaining the degree of electric contractility that they possess, we are able, as a general rule, to determine whether the paralysis is dependent upon lesion of the nervous centres or of the muscles. According to Duchenne, the readiness with which a muscle responds to the electric stimulus is in direct ratio with the extent to which fatty degeneration has proceeded, and he considers " that a palsy accompanied with an elevation, or even perfect preservation of the electric muscular contractility, or one in which it is abolished, or depressed out of all proportion to the grade of the atrophy, may at once be confidently pronounced not to be an example of wasting palsy.” In a well-marked case of muscular atrophy now under our care, the loss of contractility is in the exact ratio of the wasting process, and is well shown by the galvanic test.

Tactile sensibility is scarcely ever affected; in 3 only of the 105 cases collected by Dr. Roberts was there a little numbness of the finger ends; pain is a much more frequent accompaniment of the disease; it may have the character of neuralgia or resemble the pain of rheumatism. Excepting that the individuals affected with progressive muscular atrophy are subject to chilliness, the general health does not commonly suffer, and unless the disease invades the trunk so as to involve the muscles of respiration, there is no direct danger to life. It is essentially a chronic affection, but its duration varies considerably. Its termination may be in recovery; it may be arrested or it may prove fatal.


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"The greatest duration of a case ending in recovery was two years and a half, and the shortest eight months. Fatal cases have not been known to terminate under a twelvemonth, while one lingered for twenty-three years, another for eight, and four more beyond four years. It is important to note that cases which issue in recovery run a much briefer career than those which end in death." (p. 128.)

The fifth chapter of Dr. Roberts's book contains some interesting remarks on the etiology of the disease. The general form appears to recur at all periods of life, but both general and partial muscular atrophy are met with chiefly during adult life and before the decline. Males are very much more subject to the disease than females-in the proportion of five to one, a difference depending probably upon the greater exertion required of men than of women. Hereditary influences prevail to a large extent in the production of muscular atrophy; but it does not appear, as one might expect, that in the individual liability, muscular weakness plays a principal part.

"Several times it attacked men of remarkable muscular power, glowing health, and unusual physical endowments. In nine instances a certain weakness had existed from early youth, but seven of these owned a hereditary cause, and the eighth was not a simple case, being complicated with mollities ossium. Indeed it might be said without exaggeration, that the victims of wasting palsy are the strong, the healthy, and the intelligent."

Besides hereditary predisposition, cold and wet, and hard work, appear to be the only special causes discoverable." Syphilis is also mentioned, but our author can only find one case in which this cause seems to have operated, to which we could contribute another not yet published.

The morbid anatomy of the disease is carefully detailed in the sixth chapter. The main features consist either in a simple removal of the sarcous elements of the muscles affected, or in a substitution for them of granular and adipose matter. A corresponding change in the external and microscopic appearances will take place. When there is much fatty deposit there will necessarily be little wasting, but in both cases the change of function will have been the same during life. In the fifteen cases in which post-inortems were made the brain was found free from disease; in nine out of thirteen where the spinal cord was examined, it was healthy ; four presenting deviations from the normal condition. Of these, three showed softening, and the fourth amylaceous degeneration, but the parts affected differed in each case, so that no conclusion as to the intimate nature of the disease could be drawn from these conditions.

The last chapter of the work is devoted to the treatment of the affection. Where so much is new and obscure, and where the opportunities for testing the efficacy of remedies are comparatively so rare, it is not surprising that the results of Dr. Roberts's treatment shonld not as yet have been very satisfactory. Yet there are other diseases with which we are more familiar, and the therapeutics of which are scarcely more advanced than those of progressive muscular atrophy. The rational view of the disease would naturally induce us to look for the remedies among those which improve nutrition and act as local stimulants to the muscular and nervous tissues. Dr. Roberts advocates the employment of mercurials and iodides as alteratives, and where we have a constitutional disorder like syphilis, or when the poison of lead is in the background, it is probable that these remedies may aid in restoring the affected muscles. Thermal and sulphur-baths have been found beneficial, a circumstance we specially alluded to in speaking of Dr. Wetzla's little book on the curative properties of Aix-la-Chapelle.* It appears, however, that of all the various remedies, none is so decidedly efficacious as the localized application of galvanism, or to use Duchenne's term, Faradization. Being essentially a local disease, it is but natural that we should seek for a local remedy, which by insuring the full action of the feeble muscle, and thus maintaining its proper function, should also maintain the integrity of its structure. This indeed is found to be the case if the induced current is applied immediately to the muscle affected. Duchenne's and Becquerel's works give us the best and most satisfactory information upon these points, and encourage us to place much faith in the application of galvanism to the muscles in which fatty degeneration has commenced its ravages.

In taking leave of Dr. Roberts's book, we can only express the gratification we have experienced in its' perusal. It contains a good summary of what is known on the subject of progressive muscular atrophy, and is evidently written by a man who thinks and observes for himself. We cannot quite consent to the propriety of the term which Dr. Roberts substitutes for that selected by Cruveilhier; it does not appear to us more distinctive or definite. It is well not to multiply names, but where a change is required, it should be made so as to insure a more ready comprehension of the meaning to be conveyed. For our parts, we think that “ Muscular Palsy” would, by indicating

” at once the main symptom and the manifest seat of the disease, meet the requirements of the case better than Wasting Palsy; but we are content to abide by the term chosen by Cruveilhier, or perhaps, best of all, to name it after him, “ Cruveilhier's disease."


• British and Foreign Medico-Chirurgical Review, Oct., 1856. + This was written before we had received Dr, Friedberg's book on Myopathia, which will be reviewed in our next--ED.

One suggestion, and we have done. We think that Dr. Roberts might improve his tables: they are not always quite intelligible, nor have we been able by analysis in all cases to satisfy ourselves that the items and the totals correspond. He has evidently bestowed considerable labour upon them, but we think that by simplifying them, the end he has in view, of laying certain results more palpably before his readers, would be more completely and readily gained.


Bibliographical Record.




Art. I.- Ophthalmic Hospital Reports, and Journal of the Royal London Ophthalmic

Hospital. Edited by J. F. STREATFIELD. Nos. 1-3.—London, 1857–58. A PERIODICAL of moderate price, recording the march of ophthalmic science in this country, has been a desideratum. The · Annales d'Oculistique' and the Archiv für Ophthalmologie,' afford valuable means for inter-communication on the Continent. With us, though the medical serials are open to communications on ophthalmology as on other branches of medicine, ophthalmologists have not possessed a special vehicle for their literary efforts, and their productions have not received that prominence which the importance of the subject demands.

We are happy to say that in the journal before us there is promise that due regard will be had to the quality of the papers published, that controversy is to be discouraged, and regard is to be had to the standard of the articles accepted; indeed, if we may judge from the contents of the three first numbers, a prosperous career may be predicted for this our youngest literary brother.

The history of the Ophthalmic Journal' is briefly this. The medical staff Royal Ophthalmic Hospital, conscious of the extent of the field presented to them at that institution, decided, on the 25th of August last, to issue a periodical record of ophthalmic observation and experience, considering that at Moorfields alone much valuable information is gained and lost that might be advantageously preserved. With proper liberality they have opened its pages to other contributors, and the papers that have yet appeared are of a high order.

The contents of each number are arranged under three heads—Facts and Observations, Original Communications, and Quarterly Reports of the Operations at Moorfields. Of this division we entirely approve, and also of the practical character of the various communications.

The first number contains a brief but interesting account by the editor, Mr. Streatfield, of a plan that he has adopted with success, for reinstating the pupil when obstructed by false membrane; a valuable paper by Mr. Bowman, On the Treatment of Lachrymal Obstruction; and a third by Mr. Poland, On Protrusion of the Eyeball.

The second number is principally devoted to the retina, and to the treatment of glaucoma, first suggested by Von Gräfe, which has excited an active controversy on the Continent and in Great Britain. Besides a paper by Mr. Critchett on the subject, there is a valuable article by Mr. Hulke, On the Morbid Changes which occur in the


Choroid and Retina, with the Ophthalmoscopic Appearances to which they give rise.

Colloid disease of the choroid, a recent addition to our knowledge, mainly due to the labours of Donders and Heinrich Müller, is accurately described. It must not be confounded with colloid cancer, to which it has no affinity; it is characterized by the inner surface of the choroid being studded over with small transparent, highly refractory bodies, which project more or less from the surface, and have a globular, club-like, or button-like outline. Donders places their origin in the hexagonal pigment cells; Müller, on the other hand, considers them adventitious thickening of the elastic lamina supporting the hexagonal epithelium ; Mr. Hulke states that the appearances favour the supposition that they have their origin in the chorio-capillaris beneath the elastic lamina. The colloid globules are very prone to calcify, forming strong glandiform masses or beads of a dull glassy aspect. This peculiar disease is most commonly met with after middle age, and its earlier stages are not attended by any appearances which can be appreciated without the microscope ; but later, the choroid presents under the ophthalmoscope a blotched, patchy appearance, due to the irregular distribution of its epithelium.

Dr. Bader has written an interesting paper on an obscure disease of the retina, which he proposes to term “ Softening of the Retina," and we regret that our space will not admit of our doing more than bespeak attention to this communication, which has been drawn up with great care, and is illustrated by several figures in chromo-lithography. The introduction of superior illustrations is a feature in the journal, and increases its utility.

The third number is more varied in its contents, and the circle of its contributors is extended. There is an account by Dr. Von Gräfe of his operation for glaucoma, which he considers to have been misunderstood and mis-stated in a recent paper; though the editors have wisely determined, as a rule, to reject controversial communications, this is a proper exception, enabling us to comprehend precisely the views and the objects of the able Berlin professor. There is a paper by Mr. White Cooper, illustrated by several sketches, giving an account of a very singular microphthalmic family, in which three children of perfectly healthy parents present in a marked degree arrested development of the eyes, of the teeth, and of the frame generally. Mr. France contributes a curious case of duality of pupils in both eyes; and singular examples of coloboma iridis and eccentric position of the pupils are recorded by Mr. Dixon and Mr. White Cooper. Dr. Bader has furnished the particulars of the ophthalmoscopic and histologic appearances in certain cases of near and weak sight; and Mr. Streatfield describes a new mode of treatment in entropium and trichiasis, by excising a strip of the tarsal fibro-cartilage parallel with the margin of the eyelid.

Thus we have presented to us a liberal and varied bill of fare. If the work be conducted on the same principles and with the same care that is apparent in the first three numbers, the editor looking to the quality of the communications without favour or affection, and rejecting such as have a marked tendency to self-laudation, the Journal will be received with respect, and cannot fail to meet with the support of the profession.

Art. II.— Transactions of the Medical Society of the State of New York for the Year

1858.--Albany, 1858. pp. 655. CONSIDERABLE activity appears to prevail among the medical men of the United States; we often have occasion to introduce the results of their labours to our readers, commonly in terms of high praise, though at times not without some expressions of disapproval. The volume before us is the produce of a single State, which has other important literary representatives. The papers

, partly only of local and personal interest, partly presenting features deserving of the attention of the profession at large,

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