MEDICAL HERALD

ST. JOSEPH, MO.

VOLUME XXit.

CONTRIBUTORS, 1903

BOSTON MEDICAL

JUL 6 1904

NEXT MEETING AT COUNCIL BLUFFS, IA., MARCH 19, 20, 1903.

DEAR DOCTOR:-You are cordially invited to attend the semi-annual meeting of the Medical Society of the Missouri Valley, to be held in Council Bluffs, Iowa, Thursday and Friday, March 19 and 20, 1903. The membership of this association includes the representative men of Iowa, Nebraska, Missouri, Kansas, North and South Dakota, and the meetings, which are held twice each year, are largely attended, and intensely interesting. An excellent program is being prepared, and a feature of the first day's session will be a symposium on Syphilis, to which contributions have been promised by Drs. Richard C. Moore, A. C. Stokes and F. E. Coulter of Omaha, Neb.

The program will be limited to twenty-five papers. If you wish to contribute, send the title of your paper at once to the secretary, and it will receive prompt attention.

In view of the fact that Council Bluffs is the birth-place of this association, together with its central location, there is no doubt but what the meeting will be largely attended. Make up your mind now to be with us.

PAPERS READ AT THE FIFTEENTH ANNUAL MEETING, SEPTEMBER EIGHTEENTH, SIOUX CITY, IA.

CHRONIC MUSCULAR ATROPHIES OF SPINAL ORIGIN-WITH REPORT OF CASES.

F. E. Coulter, M. D., Omaha, Neb.

HAVE selected the term "Chronic Muscular Atrophies of Spinal Origin" as the title of this paper because it seems the more nearly and clearly to describe the cases under consideration than any other. Progressive muscular atrophy was a term first used by Aran in 1850 to describe a condition that is seldom found existing alone.

Charcot regarding the primary lesion as located in the pyramidal tracts gave to this condition the name amyotrophic lateral sclerosis, a very good. name indeed, but scarcely as descriptive as the one chosen it would seem.

Before proceeding to the report of the cases, let us discuss briefly the varieties one is likely to encounter of this disease, especially from a clinical point of view. From the names already referred to, you have inferred that the seat of pathological change is not confined to one location. The signs and symptoms, taken in their entirety, may be divided into one of three divisions, not absolutely separate and independent of each other how. ever, and these various divisions signify to some extent the region invaded.

First. If the ant. horn cells of the cord are the principal seat of the disease, one observes pronounced nutritional alterations in the muscles depending on those particular cells, then weakness, atrophy and altered electrical changes are the prominent features, sensory alterations being absent.

Second. If the pyramidal tract be the prominent seat of alteration, then spasticity, rigidity, increased myotatic irritability and plus reflexes is the picture observed.

The third division is manifest, when the scene of pathological operation is found in the structures of the medulla, the change being the same in character, simply analagous structures being affected, but because of the cranial nerves being involved, a somewhat different manifestation is observed. It is quite apparent then that this last condition may be present in either of the other two, in fact often is, and also that the first and second may be present in varying proportions in different cases, hence, one case may seemingly have a preponderance of ant. horn cell disturbance and slight pyramidal tract change together with bulbar symptoms; another may be found with a preponderance of pyramidal tract alteration and slight

ant. horn cell change and bulbar signs, or in rare instances as the case first reported, the bulbar may be the first manifestation of disease and other changes come later.

The term "progressive muscular atrophy" then is applied to those cases in which there is pronounced ant. horn changes, and little alteration in the pyramidal tract, while amyotrophic lateral sclerosis is reserved for pronounced pyramidal tract alteration, and not much ant. horn change.

"Gowers," as you know, places them all in one group and calls them "chronic spinal muscular atrophy," and from the pathological findings it would seem this was wise, as very few authentic cases have been recorded in which both regions of the cord were not involved.

HISTORY OF CASE NO. I.— H. S. G., male, 64, native United States; married; carpenter and engineer.

Family History-Father died at 94, old age. Mother died at 79, typhoid fever. Brothers nine, eight living, all in good health. One died of inflammation of bowels. Sisters two, one died child-birth, one living in good health. Family disease nil.

Social Habits.--Temperate as to alcohol, chews a little tobacco; surroundings good, otherwise nil

Previous History.-Early life always healthy; measles, no scarlet fever or diphtheria; married four times; first at 22, five healthy children by first wife. Six healthy children by second, none by third or fourth. No miscarriages any wife. Trauma L. face, malor bone injured at 20, was unconscious one day, recovered well. At 34 terminal phalanx L. thumb shot off. Denies every kind of venereal disease; has been subject to considerable exposure. No other trouble of any kind.

Present Illness.-April and May, 1901, noted he could not talk quite natural, but about this time he had his teeth removed, and thought it was from this cause, however, it gradually became worse, so that by the latter part of June speech was very indistinct. In May noted difficulty in swallowing solid food, and by July could not "get it down at all;" about this time also he began to bite his tongue considerable, and his tongue became stiff and he could not protrude it as well as formerly, and the last four or five months not past the lips. He also noted he could not open his mouth so wide as before, and that the saliva began to drop from it at times. The last few weeks noted that a phlegm would accumulate in back of throat considerable. No numbness in mouth or tongue at any time; food tastes quite natural. Has been unable to whistle for the past six months. No alteration in penmanship. Thinks he is as strong as ever in all parts of the body, but this statement is now warranted by the facts, as the examination demonstrated; he also thinks there has been but little alteration in his condition for the past four to six months.

On examination a rather well preserved male, considering the age, expression solemn and serious in type; R. eyebrow and lower R. face inclined to droop, development is medium. Intelligence fair, attention and memory good.