IN THE VOLUNTARY MUSCLES. 243 



under defects and peculiarities of a precisely similar kind, differing only in degree. The pecu- 

 liarities and defects of the younger brother were much less in degree, and he derived more 

 benefit from his stay in the Hospital, improving considerably in power and readiness of move- 

 ment, and becoming capable of rising from the ground without assistance, whenever he hap- 

 pened to fall. In temper and bad manners also he resembled his brother, but had these 

 failings in a less degree, and was more amenable to discipline and less insensible to kindness. 

 He had likewise had the lientery — indeed up to the time of his admission to the Hospital. 

 Both the cases were treated with Cinchona, full diet, air and exercise. 



Their parents have three other children living, viz. a son aged ly, a daughter aged 7, and 

 an infant in arms. Only Joseph and Thomas have any personal defect. During their 

 mother's pregnancy with these two she was living (where she lived many years) in a damp, 

 malarious locality near some clay-pits by the bank of the New Bedford River. She had ague 

 several times ; she had it during these two pregnancies ; and during the last three months of 

 each she also suffered from pains darting from pubes to sacrum and down the front of her left 

 thigh ; and the limb was paralytic, so that she dragged it in walking. She has had no such 

 symptoms in her other pregnancies; and on the two occasions on which they did occur, they 

 ceased at the time of her delivery. Between her eldest son and Joseph she had four children, 

 all of whom are dead ; the first of them died, when 2 years old, of Chronic Hydrocephalus, 

 and the third died in fits. The father is hearty and strong : the mother is well-made, and 

 not of nervous temperament; but a sister of hers has a child 7 years old,, which, as I am 

 informed, has never been able to stand, and until lately has been unable to articulate. 



The abnormities in the muscular systems of these boys are remarkable in occurring sym- 

 metrically on the two sides. They are remarkable in not being associated with any manifest 

 deformity of the bones. Another notable peculiarity is that they are of two different, indeed 

 opposite, kinds;. — some of them characterised by defect, and others by excess of muscular 

 development. 



In speculating as to their cause, the first question is whether they were congenital, or the 

 result of changes in muscles that had been well-constituted at birth. With regard to the 

 deficiencies, it can scarcely be doubted that they were congenital. This is the natural infer- 

 ence to be drawn from the mother's statement. But can the same be said of the abnormities 

 characterised by excess? I think not. 



Prima facie, it is improbable that during foetal life one part of the muscular system should 

 fall short of its normal development, and another go beyond it : and in the next place we have 

 the evidence of the boy's mother, who says that his calves were not of disproportionate magni- 

 tude before he began to walk. We are therefore led to separate the abnormities into two 

 classes, viz. those which were congenital, and those which had their origin after birth ; — and 

 these have opposite characteristics, the muscles being deficient in the former and unnaturally 

 large in the latter class. 



Are these very dissimilar abnormities related to one another ; and if so, what is the nature 

 of their relation .'' 



I am inclined to think they stand to one another in a very close relation — that of cause 

 and effect. It is easily intelligible how a primary defect in the muscles of the upper arm and 



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