. A treatise on nervous and mental diseases, for students and practitioners of medicine. ypertrophic muscular paralysis,one (sitting) in the late stage, the other (standing) in the early. History. The disease was first really described by Duchenne,of Boulogne, in 1858, who denominated it hypertrophic paraplegia NEURO-MUSCULAR OR MUSCULAR DISEASES. 285 of infancy, although Charles Bell in 1830, two Italian observers in1838, Partridge in 1847, and Meryon in 1852, had put cases of iton record. Since Duchennes description of it in his famous text-book, it has been generally recognized, but the bes
. A treatise on nervous and mental diseases, for students and practitioners of medicine. ypertrophic muscular paralysis,one (sitting) in the late stage, the other (standing) in the early. History. The disease was first really described by Duchenne,of Boulogne, in 1858, who denominated it hypertrophic paraplegia NEURO-MUSCULAR OR MUSCULAR DISEASES. 285 of infancy, although Charles Bell in 1830, two Italian observers in1838, Partridge in 1847, and Meryon in 1852, had put cases of iton record. Since Duchennes description of it in his famous text-book, it has been generally recognized, but the best essays upon thesubject have been by Gowers in 1879, Schultze in 1886, and Ray-mond in 1889. Clinical History. The disease generally commences in earlychildhood with symptoms of weakness in the lower extremities, towhich attention is first called by the patients stumbling or fallingfrequently. As the malady progresses the gait of the patient be-comes characteristic, with legs spread wide apart, shoulders thrownback, and waddling; and it soon becomes evident that the lower Fig. Photograph of case of pseudo-hypertrophic muscular paralysis, showing the differencein size of the upjjer and lower extremities, and the helplessness. limbs are increasing in size. If the child is examined at this time,it will be found that it has a peculiar difficulty in getting up fromthe floor upon which it has been placed, or from a chair, or in goingup stairs. He first puts his hands upon his knees, then grasps histhighs higher and higher, and so, as Gowers says, by climbing nphis thighs he rises to the erect posture. Gowers considers thissymptom ])athognomonic, and I am inclined to agree with him. Themuscles will also be found to be increased in size in varying degree,as is shown in Figs. 141, 142, and 143. Tlie u]jper extremities, and also the muscles of the neck and face,are rarely affected. The hypertroj^hied muscles are weak, as can bedetermined by testing them in the proper way (p. 152)
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