MTTLTIGLAKDTTLAR SYNDROMES 



915 



enormous. But this hypertrophy is not commensurate with power. In- 

 deed, their power diminishes quite, if not entirely, as rapidly as that of 

 the atrophied muscles. For the hypertrophy is not a true increase of 

 normally acting muscle fiber, but of interposed fatty bundles with de- 

 generated muscle. At times the hypertrophy is entirely innocent of har- 

 boring any normally acting muscle tissue whatever, but is a mass of gray- 

 looking, fatty consistency. Occasionally the subscapularis, or the infra- 

 scapula? or the serrati appear hypertrophied. The increasing disability 

 limits more and more the voluntary exercise of the body, the contractures 



Fig. 15. Scoliosis in muscular dystrophy showing marked unilateral weakness 

 of muscles of back. 



become more and more pronounced, the atrophy is increasingly evident, 

 and finally nothing but an apparent skeletal framework with little or no 

 muscle covering, and in all positions of contraction, results. Lordosis 

 arises early in the disease. Death ensues, either through intercurrent 

 disease or through the increasing asthenia. There are all grades and com- 

 binations of atrophy and hypertrophy as there are all rates of progress 

 in the disease, from one of intermittent remission with only gradually 

 increasing disability so that ages of eighty years and over may be attained, 

 to the fulminating cases lasting but two or three years, with rapid 

 exhaustion. Various causes for the occurrence of the disease are given. 

 Most investigators believe that heredity is a great factor, although Seegard, 

 on the basis of twenty-one cases, denies this. Intelligent patients with 

 the disease frequently give such causes as accident, emotional stress, acute 



