OSLER, IDIOPATHIC MUSCULAR ATROPHY. 2t51 and, if anything, seems to respond to the arsenic a little more quickly than the leucocyte line. The general condition of the patient at present is very good. His symptoms have throughout corresponded pretty well with the blood im¬ provement. His girth is thirty-four or thirty-five inches in place of forty or forty-one. The lower right border of the spleen has retreated to the middle line, or a trifle to the left of it, below the umbilicus. The upper

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... border is above the costal border, but still further from the middle line than at first; so that the reduction in size of the spleen has been very considerable, involving, I should say, a shortening of its larger diameter four or five inches. It is now freely movable and the abdomen is soft. He has had no epistaxis of any extent since Christmas; he has no fever, no night-sweats, no dyspnoea or cough. His appetite is excel¬ lent; he looks and feels very well. HU weight, notwithstanding the diminution of girth, has increased several pounds. PB0FZS80K or mxdicimc, joiihb iiopxiks ukivxhbitt, baltimobk. In the classification of primary myopathies, the difficulties have been greatly increased by the description of forms depending upon the situa¬ tion of the atrophy. Varieties of the same disease have been described as separate maladies, and from the inevitable confusion we have scarcely escaped. Erb has simplified matters very much by grouping all the forms under one designation-dystrophia muscularis progressiva-of which two chief types are recognized: (1) With primary hypertrophy, the pseudo-hypertrophic muscular paralysis. (2) With primary atrophy. As cases of pseudo-hypertrophic paralysU occur in which atrophy and hypertrophy exUt in the same muscle, or wasting occurs in one group and enlargement in another, or atrophy in one group precedes for months the development of hypertrophy in another, it is not surprUing that these two forms are regarded by many as identical. Gowers, however, calls attention to the fact that, when cases of atrophy occur in families, they never present the features of pseudo-hypertrophic disease. It is in the cases with primary muscular atrophy that the greatest confusion exUts in classification, and the following forms have been recognized and described: