MULTIGLANDULAR SYNDROMES 905 



muscle fibers and at times the muscle seems to have degenerated to a 

 gray fatty mass. But more intensive and exhaustive examination further 

 disclosed the fact that it was not only in the muscular system, but also in 

 the bony skeleton and in the connective tissues and glandular elements 

 that degenerative changes occurred. And as case after case was reported 

 in full, it could be gradually seen, as though a, curtain were gradually 

 lifted, that more and more often, combined with the muscle dystrophy, 

 there occurred concomitant disturbances indubitably dependent upon 

 glandular dysfunction. Such were exophthalmic goiter, urticaria,, hyper- 

 thyroidism, acromegaly, nyctalopia, prognathism, sexual infantilism, 

 abnormal pigmentation, and so on. Keen observers, such as Erb, Marina 

 and Jendrassik, had also noticed that in one case each of true progressive 

 dystrophy that had come under their observation, a spontaneous cure had 

 been brought about in the adolescent period, and each one had arrived at 

 the same conclusions independently of the others, that the cures had 

 resulted from a restoration of a disturbed balance in the internal secretory 

 organs. Levi and Rothschild reported a case in 1907 which had made 

 considerable progress under pituitary extract administration. Then in 

 1916, two important observations were made. The former by McCrudden 

 and Sargent was the fact that progressive muscular dystrophy was accom- 

 panied by a hypoglycemia which accounted for the extreme fatiguability 

 of the victims, and that glandular therapy consisting of combination of 

 pituitary extract and epinephrin were of distinct value in the disease; 

 and the latter by Timme, that the large majority of cases showed early 

 calcification of the pineal gland and that borderline cases in which dys- 

 trophy was not the marked feature but fatiguability was the outstanding 

 complaint, also showed these pineal shadows; furthermore, that pineal 

 tumors gave rise to many of the symptoms seen in progressive muscular 

 dystrophy. In 1917 Janney, Goodhart and Isaacson made metabolic 

 studies of a number of cases of progressive muscular dystrophy and came 

 to the conclusion that the changes demonstrated by them to exist were 

 similar to those produced by dysfunction or removal of any one of several 

 of the ductless glands, notably the thyroid, suprarenal or pituitary. Hence 

 it seems that the time is ripe to include in any multiglandular study some 

 reference to the syndromes presented by the muscular dystrophies and 

 asthenias. 



Classification. Types of Progressive Muscular Dystrophy. The 

 classification adopted by Erb of the various types of this disease was 

 accepted by Charcot and Marie, and is here reproduced as being sufficiently 

 general to include all types that have been described. 



1. Dystrophia muscularis progressiva (infantum). 

 a. Hypertrophic form. 



(1) With pseudohypertropJiy. 



(2) With true hypertrophy. 



