906 WALTER TIMME 



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b. Atrophic form. 



(1) With primary facial involvement (Duchenne's in- 



fantile form). 



(2) Without facial involvement. Simple alrophic form. 

 2. Dystrophia muscularis progressiva juvenum ct adultorum (juve- 

 nile form). 



It is characteristic of the familial, hereditary forms to exhibit con- 

 ditions at times of one of these groups, at others, of another group; so 

 that in several generations of the same family individuals will be found 

 to conform with almost any one of the types outlined above. 



Types Manifesting Endocrinopathic Features. We shall dwell chiefly 

 upon those types of progressive muscular dystrophy that accent the endo- 

 crinopathic characteristics. Various authors have described atypical 

 forms of muscular dystrophy, that is, they were atypical either in their 

 course or their chronicity, or else in the groups of muscles affected or in 

 the intensity of such impairment : in the presence or abserice of contracT 

 tures; in the slow or rapid involvement of the entire skeletal structure, 

 together with the muscular, making of the patients helpless cripples, and 

 ending in death in a comparatively short time. It will also be noticed 

 that as we progress the recent authors show more and more marked a 

 tendency to include symptoms referable to the sympathetic nervous system 

 and the endoerin glands. 



Barsickow's Group. Barsickow's group is late in appearance, slowly 

 progressive and not fatal. It was the first group of great importance, 

 studied by Barsickow in 1871, and consisted of twenty-four cases occurring 

 in two families from one ascendant through five generations. It is pre- 

 sented in extenso because of its importance. A composite picture of Bar- 

 sickow's cases showed that the members of the widely scattered families in 

 which they arose were as a rule in good health and lived to be old. The 

 great grandfather had only a stiffness in gait and carriage, and yet twenty- 

 three of his descendants (five out of seven of his immediate children) 

 showed muscular disease, not only in function, but also in muscle volume. 

 The members seem to have been attacked without rule, seemingly showing 

 some predisposition in heredity. The children remained healthy if the 

 parents were unaffected, and there were an equal number of males and fe- 

 males attacked. The cause of the original incidence, Barsickow states, was 

 probably lead poisoning, for this original grandfather was a typesetter and 

 bad had many attacks of lead colic. In some cases chlorosis, cholera and 

 varioloid acted as preceding agents conducing to the development of the 

 trouble. The onset in seventeen of the cases was at the following ages: 

 five between the ages of 10 and 20, seven between 20 and 30, and five 

 later in life. 



The condition was ushered in by almost simultaneous affection of both 

 an upper and lower limb, or both upper and lower limbs. The serratus 



