912 WALTER TIMME 



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at the advanced age of 46 and was not familial. It came on after a 

 first pregnancy complicated with phlebitis. She became immediately 

 bed-ridden, and remained so until her death at 63 years. The postmortem 

 examination showed, besides the usual muscle condition, changes in the 

 thyroid, which had developed a large colloid struma with but a little 

 functionating tissue, and a small tumor in the spleen, softened supra- 

 renals, small pancreas, somewhat atrophic ovaries and small fatty deposits 

 in the liver. This case is interesting and suggestive as having developed 

 after a disturbance of the ovaries due to a late first pregnancy. 



Boveri described several members of a family afflicted with muscle 

 dystrophy in which some of the muscles had been entirely replaced by 

 fibrous tissue or fatty tissue, and thought it remarkable that all of the 

 patients had also exophthalmic goiter. Collins and Climenko, among 

 their numerous cases, make mention of the general growth anomalies in 

 several, apart from the general muscular dystrophy. Thus, one patient 

 had a general adenitis with abnormal teeth, especially the incisors, and 

 undescended testicles. Another one had spongy gums, poor and irregularly 

 placed teeth, a high arched palate, long uvula with large tonsils; at the 

 age of 14 this patient was undersized and had as yet no signs of puberty. 



Other authors report the presence of anomalies in the skull with 

 asymmetry. Seegard in 1905, on the basis of twenty-one cases, disputed the 

 hereditary factor in the etiology and claimed the entire process to be a 

 metabolic one. 



McCrudden and Sargent, in a careful laboratory study of a case of 

 progressive muscular dystrophy, showed that a condition of hypoglycemia 

 probably underlay the great muscular fatiguability. On account of the 

 close relationship between hypoglycemia, muscular asthenia and deficiency 

 of the suprarenals and hypophysis, epinephrin and pituitary extract were 

 administered with resulting improvement in health, strength and weight. 



In 1916 Timme (a) presented a series of 14 cases in one family occur- 

 ring through three generations ; six of the patients he had examined person- 

 ally. The characteristics were the usual atrophy and hypertrophy, but the 

 course in all was extremely benign. Timme stresses the point that five of 

 the six showed pineal shadows in the rontgenogram, even though some of 

 the affected members were only adolescents. lie presents, in juxtaposition to 

 the symptoms presented by these cases the characteristics of many patients 

 known to have pineal tumors which had been confirmed by autopsy. The 

 literature gives many such. There are many striking resemblances in 

 the two groups. Timme concludes that too early pineal involution may 

 be responsible for many of the symptoms of progressive muscular dys- 

 trophy. He cites cases also that give symptoms of fatiguability only of the 

 dystrophy syndrome without apparent muscular disturbance, and in them 

 he likewise finds pineal shadows. Evidently, according to his views, early 



