Identifier: treatiseonner00sach (find matches)
Title: A treatise on the nervous diseases of children, for physicians and students
Year: 1905 (1900s)
Authors: Sachs, Bernard, 1858-1944
Subjects: Nervous system Children
Publisher: New York, W. Wood and company
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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. The disease, as Hoffmann has shown, inrare instances attacks the upper extremities first and theninvolves the lower. Hoffmann has objected to the use ofthe designation leg type, but since in this form thelegs are involved at a very early stage, whether the diseasebegins in them or in the upper extremities, it seems properfor the present to retain this designation. The atrophy inthe upper extremities may involve the small muscles of thehand, the extensor and flexor muscles of the forearm or the * This disease is also known as the type of Charcot-Marie-Tooth. Hoffmann sug-gested the term progressive neurotic, Bernhardt, the term progressive neural,muscular atrophy. 36° THE NERVOUS DISEASES OF CHILDREN. arm, and may cause a wasting of the muscles about theshoulder-girdle. I have seen the infra- and supra-spinatiespecially wasted in several of these cases. The atrophyin the upper extremities is, as a rule, not so distinct nor soearly a symptom as in the cases of the Aran-Duchenne type.
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Fig. 84. — Two Brothers afflicted with the Peroneal Form of Progressive MuscularAtrophy, Eight Months and One Year respectively after First Operation. Sensory changes are generally present, and serve as animportant point of differentiation between this special formof atrophy and a spinal amyotrophy. The various formsof sensation may be slightly altered, or, in some cases, tac-tile sensation and temperature sense may remain normal,while the pain sense may be more distinctly involved. Par-esthesias may be present in addition to the objectivechanges in sensation. The reflexes in the lower extremitiesare either diminished or lost; the exact state of the reflexes PROGRESSIVE MUSCULAR ATROPHIES. 361 depending somewhat upon the stage of the disease at thetime the patient is examined. The electrical reactions inthe atrophied muscles are, as a rule, altered. The changesare not so extreme as in the cases of spinal amyotrophy,nor are they as mild as in the primary muscular dystrophies.The reac

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