Atrophy

“ DEFINITION.—A diminution in size and weight of the organ, due to degeneration and atrophy of the muscular fibres.
The old writers applied the term phthisis of the heart to this condition. The decrease is always in weight, and usually in size; it is doubtful if there is an atrophic and dilated heart in which, with the wasting, the size is maintained by the dilatation. In many of the degenerations, particularly fatty and fibroid, there is local atrophy of the muscle-fibres and yet the weight and size of the organ are not changed. ”

“ Thus, in the case of the heart, when affected with fatty degeneration, there is atrophy of the proper muscular texture, which, however, being largely replaced by fatty matter, the organ may undergo no diminution in volume, but may, on the contrary, be increased in size. Atrophy is usually a gradual and slow process, but some times it proceeds rapidly. ”

“ From section, disease, atrophy or degeneration of nerves or nerve centres, the muscles, which they normally innervate, waste, often to an extreme degree. As examples of this we see the atrophy of the triceps extensor cruris and other groups in hæmoglobinuria, of the intrinsic laryngeal muscles in roaring, of the muscles supplied in neurectomy, and of groups of muscles in myelitis, broken back, lead paralysis, and scapular muscular atrophy. True to the law of wasting of physiologically inert organs, the nerves are atrophied and degenerated, and often also the bones, joints and skin. ”

“ The atrophy begins within a week after the paralysis, and its progress is even more rapid than that following the section of a nerve. Sometimes all the flesh on a limb is shrivelled down to the bone; at other times the muscular atrophy is concealed by an abnormal development of fat, constituting a pseudo-hypertrophy. When all the muscles surrounding a joint are equally paralyzed and atrophied, no deformity develops,51 unless, indeed, the segment of a limb is used by means of the non-paralyzed proximate segment. ”

“ The disease is transient, and there are no mental symptoms.
Progressive muscular atrophy has been observed as far back as Hippocrates, but it is only in recent times that we have had any definite knowledge of the subject. It is divided into four types, the hand type (causing the griffin-or claw-hand, or the ape-hand) ; the juvenile type (generally in the muscles of the shoulder and arm) ; the facial type; and the peroneal type. Generalized progressive atrophy leads to a condition that simulates the appearance of a "living skeleton." ”

“ In the lower extremities and pelvis primary pseudo-hypertrophy is the rule; atrophy is almost invariably secondary, and below the hips is rarely excessive.33 In the upper part of the body primary atrophy is the rule for certain muscles, and succeeds rather early to the pseudo-hypertrophy which affects others. Only a few muscles habitually hypertrophy, and remain enlarged until a somewhat advanced period of the disease. ”

“ Again, long-standing disease, by affecting the nutrition of an organ and by inducing the deposit of morbid products, may result in atrophy, as frequently happens in affections of the liver and kidneys. Parts that are subjected to continuous pressure are liable to become atrophied, as is sometimes seen in internal organs which have been pressed upon by tumours or other morbid growths, and is well illustrated in the Chinese practice of foot-binding. Atrophy may manifest itself simply by loss of substance ”

“ In some instances the so-called "living skeletons" are merely cases of extreme muscular atrophy. As a prominent example of this class the exhibitionist, Rosa Lee Plemons at the age of eighteen weighed only 27 pounds. Figure 177 shows another case of extraordinary atrophic condition of all the tissues of the body associated with nondevelopment. These persons are always sickly and exhibit all the symptoms of progressive muscular atrophy, and cannot therefore be classed with the true examples of thinness, in which the health is but slightly affected or possibly perfect health is enjoyed. ”

“ There is reason to believe, too, that this form of atrophy is one of the consequences of senility—that the tendency to connective-tissue overgrowth which characterizes old age operates to produce, in a way to be presently explained, an atrophy of groups of muscles. In a woman aged seventy, now under my care, the fingers of both hands are clawed—became so inappreciably almost, and the condition is still increasing. ”

“ For convenience sake atrophy may be divided into abortion and degeneration, the first including cases where, from arrest of development occurring at an early stage, organs are present; but in a much smaller and more rudimentary condition than usual, their form and general appearance, except so far as regards their dimensions, not being materially altered. On the other hand, in cases of degeneration, development is not entirely checked, but rather perverted, so that not only the dimensions are lessened, but the form is altered. ”

“ Treatment.—Treat the same as for hypertrophy of the heart.
Cardiac Atrophy.
—Definition.—Cardiac atrophy is a [325] decrease in the size, strength, weight, and activity of the heart.
Treatment.—Remove blood by drainage, and inject half strength fluid for the first part of the injection. The amount of fluid need not be as great as in the acute disease of the heart. Massage the face downward. Give cavity injection. For transportation, govern yourself according to the provisions of the transportation rules. ”

“ As the cell fails and shrinks, so does it become more and more unable to make good the waste due to metabolism. This physiological wasting is termed senile atrophy.
General atrophy or emaciation is brought about by the tissues being entirely or partially deprived of nutriment, as in starvation, or in malignant, tubercular, and other diseases of the alimentary system which interfere with the proper ingestion, digestion or absorption of food material. ”

“ It has been long known, that the muscle as the result of frequent functional excitation by means of adequate nerve impulses, that is, prolonged activity, is considerably increased in size, whereas in the absence of such it loses more and more in volume. A hypertrophy of activity, produced by functional stimuli, and the atrophy of inactivity, the result of the discontinuance of the functional excitation, is universal and can be observed in the various tissues of our body. ”

“ I. There is a species of atrophy, which has not been well understood; when the absorbent vessels of the stomach and intestines have been long inured to the stimulus of too much spirituous liquor, they at length, either by the too sudden omission of fermented or spirituous potation, or from the gradual decay of nature, become in a certain degree paralytic; now it is observed in the larger muscles of the body, when one side is paralytic, the other is more frequently in motion, owing to the less expenditure of sensorial power in the paralytic limbs ”

“ The atrophy affects different organs in different degree and shows great variation in situation, in degree and in progress. Atrophic changes of the blood vessels are of great importance, for this affects the circulation on which the nutrition of all tissues depends. While there is undoubted progressive wear of all tissues, this becomes most evident in the case of the blood vessels of the body. It is rare that arteries which can be regarded as in all respects normal are found in individuals over forty, and these changes progress rapidly with advancing age. ”

“ A patient, with atrophy of some of the muscles of both arms of six months’ standing, which incapacitated her from dressing herself or cutting her food, or doing much household work, was discharged at the end of three and a half months, able to feed and dress herself, sew, and perform almost any domestic duty. ”

“ When a muscle is separated from its connection with the central nervous system, either by a division of the nerve passing to it or by a destruction of the cells in the anterior cornu of the spinal cord from which that nerve arises, it undergoes an atrophy which is peculiar in being immediate and rapidly progressive, thus contrasting strongly with the gradual and slighter atrophy from disuse in cases of cerebral paralysis where the cells mentioned and the nerve-fibres are intact. ”

“ Atrophy is an anatomical phase of senility, whose irregular distribution is explained by the inequality of cellular existence, and this is again dependent upon the initial impulse of contraction and upon varying states in the medium, and this by the introduction into the tissues of matters foreign to its normal structure. ”

“ One reason, no doubt, may be that his systematic overwork may produce a diminution in the energy-yielding substance of his nerve-centers, just as we see that a certain amount of atrophy occasionally occurs in overworked muscles. ”

“ I would also go farther, and express the opinion, that peripheral influences of an extremely powerful and continuous kind, where they concur with one of those critical periods of life at which the central nervous system is relatively weak and unstable, can occasionally set going a non-inflammatory centric atrophy, which may localize itself in those nerves upon whose centres the morbific peripheral influence is perpetually pouring in. ”

“ With the diminishing cell activity the blood vessels resume their usual calibre, and when the newly formed vessels become redundant they disappear by undergoing atrophy in the same way as other tissues which have become useless. ”

“ There may be hypertrophy, in which the entire organ or part becomes larger as a whole, the active cells and stroma sharing alike in the process, or there may be an hyperplasia, in which the active cells of the part proliferate abnormally. When the interstitial tissue alone develops excessively it is known as an infiltration. Under such circumstances the parenchymatous cells often undergo what is termed pressure atrophy; they are diminished by squeezing. ”

“ Histological changes in atrophied muscles vary somewhat in character in different diseases, and vary much in degree at different periods of the atrophy. An early appearance is the presence of proteinaceous and of fatty granules or molecules in the sarcous substance. Later, the muscular fibres become reduced in size, lose their striation, and show inequalities; the interstitial connective tissue becomes active and increases in amount, at the same time that fat is deposited. ”

“ In ataxy—at least in its early stages—irritability is normal. In [67] progressive muscular atrophy it is normal as long as any muscular tissue remains.|Hysterical Paralysis.| In hysterical or emotional paralysis irritability is normal, but electro-sensibility is often much impaired. |Diagnosis between Real and Feigned Disease.| |Electricity as Proof Positive of Death.| These variations will sometimes enable us to distinguish between real and pretended disease ”

“ Step by step with the progress of the anæsthesia, atrophy of the subjacent muscles supplied by the thickened nerves proceeds. Along with the atrophy there is a corresponding distortion and a corresponding loss of power. There is no ataxia or incoordination of movement simply feebleness. Thus the forearm wastes, the grasp is weakened, the thenar and hypothenar eminences and the interossei melt ”

“ It is a chronic affection, usually beginning in early life, increasing slowly for years, and then becoming stationary. It is distinguished from one-sided muscular atrophy by the electric reaction, which is not lost in the facial muscles in facial hemiatrophy, and there is no atrophy of other muscles of the body. ”

“ In these cases a single measure or practise of any kind, no matter how good or true, when persistently inculcated or exercised without timely and appropriate variation or addition, soon comes to the end of its chief usefulness; for the nature of the human mental and nervous organization predetermines that atrophy and decay in the realm of feeling and willing just as surely follow closely upon the over-exercise which produces an initial hypertrophy, as it does similarly in the physical realm. ”

“ The restriction of a healthy muscle causes it partially to lose its functioning ability, and habitual restraint and unnatural pressure brought to bear upon the muscles of the trunk result in local congestion and in displacement of special organs. Lungs, liver, and intestines, together with the organs of reproduction, suffer from the constrictive effects of the corset, and lack of nourishment, due to restricted circulation thus produced, causes atrophy of muscular tissue, since the latter is not adequately rebuilt. ”

“ When a gland is cut off from its nervous connection with the cord or cerebral axis by section of its nerves, its function is impaired and its nutrition suffers, so that after a time it loses weight and undergoes a progressive total atrophy. ”

“ If a disease should destroy life by withholding all fluids, we can trace such cause in the beginning to a time when there was watery swelling of the centers of nerves of nutrition, to such amount as to cut off nerve supply until sensation ceased to renovate and keep off accumulating fluids so long that fermentation did the work of heating till all fluids had dried up, and the channels of supply closed by adhesive inflammation, and death follows by the law of general atrophy. ”

“ If the patient is still solicitous, he notices this condition of pain and concludes that it means that the muscles are not yet in the condition of health where they should be used, and he puts on the splints, metaphorical or literal, once more. The muscles grow more flaccid and eventually atrophic as a consequence, until sometimes there will be a difference of more than an inch in the girth of two limbs at the same point, and this atrophy may proceed much farther. ”