908 WALTEK TIMME 



asthmatic bronchial attack. In this series of cases* the rapidity of the 

 course to a fatal termination is the characteristic feature. The necropsy 

 showed, among other atrophies, that the pectorals were reduced to thin 

 grayish-red, skin-like lamella?, through which the ribs showed. 



Gowers' Group. In Gowers' group the disease was early in appear- 

 ance, rapid in progress, and was fatal in adolescence. Gowers, in a 

 clinical lecture in 1879, reported four brothers, aged 9, 10, 5 and 3 years, 

 all affected, whose parents were both healthy, but whose maternal uncle 

 died at 15 of a wasting disease. These patients had a little difficulty in 

 putting their feet down on the floor on account of a tense, shortened 

 Achilles tendon. The extensors of the knee and hip were weak, the flexors 

 of the hip were feeble. The latissimus dorsi and the lower part of the 

 pectorals were gone. There were no sensory changes, the knee-jerks were 

 absent and there was a marked lordosis, The upper limbs were weak, 

 although they moved freely. Gowers reports that out of 220 cases that ne 

 collected from the literature, 190 of the patients were males and thirty 

 were females. While he mentions Barsickow's cases, yet he excludes them 

 from his statistics, because they were all of the adult type. Some gener- 

 alizations from these 220 cases are drawn by Gowers: (1) the disease is 

 almost never heard of on the side of the father; (2) the age of onset is an 

 etiologic factor of great importance and occurs in the worst cases before 

 the 6th year; the more severe the case, the earlier it begins; (3) occa- 

 sionally the disease follows physical injury; (4) shortening and permanent 

 contractions of certain muscles lead to distortions in the positions of the 

 joints; especially contraction of the calf muscles, leading to inability to 

 place the heels on the floor; (5) the patients lose the power of standing at 

 10 or 12 years of age, and death supervenes between the 14th and 18th 

 years; (6) of diagnostic importance is not the actual muscular enlarge- 

 ment, but the distribution of the muscular disease, especially the wasting 

 of the lower pectorals and the latissimus dorsi; (7) the later the appear- 

 ance of the disease, the more slowly it advances ; the older the patient, 

 the better the prognosis. 



The commentary on these cases is that some of the conclusions, 

 especially the last, are quite contrary to those reached in other types of the 

 disease, to be described hereinafter. 



Erb's Group. Erb's types are of the accepted classification of pro- 

 gressive muscular dystrophy. In one of his publications Erb gives a gen- 

 eral description of the juvenile type of the disease, saying that it begins 

 always before the 20th year and usually with atrophy of the upper arms and 

 shoulder girdle muscles and is often combined with hypertrophy. There 

 are no reactions of degeneration and no muscular fibrillary twitching. 

 The following muscles are almost constantly affected: pectorals (except 

 the clavicular portion), cucullaris, latissimus dorsi, biceps and brachialis 

 anticus and the long supinator. The glutei are weak and calves large. 



