Address on Collective Investigation
Sidney Coupland · BMJ · 1884
I_it with the point of a pencil, it responded to 8timtdation.Liquids and food also never returned through the nostrils.That it was in- volved, though to a slight degree, was manifested by his inability to sneeze or blow his nose, acts which do nbt depend in any way on the power of closing the lips.The lower facial muscles and, the tongue responded feebly to faradism, and there was no reaction of degeneration.The mind seemed to be unaffected, though at times he was very desponding, and when amused he laughed immoderately.On testing the general muscular power, it was evident that, in ad- dition to the symptoms of progressive bulbar' paralysis, for the relief of which he sought advice, his hands, upper extremities, and trunk were the seat of progressive muscular atrophy.The left hand was affected to a greater extent than the right, and exhibited the features of the "claw-hand."The dorsal interossei of each hand were atrbphied, and, ks well as the second and third left palmar, did not respond to faradism.The thenar and* hypothenar eminences were also flattened; the abductor pollicis did not respond to electri'cityv while the opponens responded very feebly.The power of grasping was greatly impaired, the dynamometer registering 12k. to the right, and 5k. to the left, hand.The forearms were soft and flabby; the deltoids, and markedly the right one, were atrophied.The patient was unable to raise his right arm to the horizontal level, and without the aid of the left hand to place the right on the 'vertex.Fibrillary mo-vements were seen in almost all the muscles, but were well marked in the deltoid, pectoralis major, triceps humeri, and flexor digitotinm.Sensation was unaffected.With the exception of the deep cervical muscles which raise and turn the head, all of which were more or less involved as to function, and probably also as to size and structure, the muscles of the trunk and lower extremities were unaffected.There was no loss of power or co-ordination while walking, and the