570 DISEASES OF THE ORGANS OF LOCOMOTION. 



CHAPTER IX. 



PROGRESSIVE MUSCULAR PARALYSIS AS A RESULT OF HYPERTROPHY 

 OF THE INTERSTITIAL FATTY TISSUE. 



IN 1869-'70 a series of very peculiar cases of progressive mus- 

 cular paralysis were published, in which the volume of the paralyzed 

 muscles was decidedly increased instead of being lessened, as it was 

 in the myopathic paralysis described in the last chapter. 



On examining the affected muscles, as was done in several cases 

 during life by excising small pieces, they showed a changed appear- 

 ance even to the naked eye. They did not have the red hue of 

 healthy muscles, but were pale and yellowish, resembling lipoma 

 more than muscle. Microscopic examination showed a decided pre- 

 ponderance of the interstitial fatty tissue over the muscular ; in 

 some places the latter was entirely displaced by the former ; the 

 muscular filaments still remaining were atrophied, pale and small, 

 but not affected with fatty metamorphosis. Hence, in this disease 

 there is proliferation of the interstitial fatty tissue, which probably 

 induces simple atrophy of the muscular fibrillse by pressure on them. 



The disease has been repeatedly observed in children of the same 

 family, and, curiously enough, only in boys. Occasionally the pa- 

 tients appeared to bring the predisposition to the disease into the 

 world with them. At least, in one case observed in my clinic, whose 

 history was published by my former assistant, Dr. Siegmund, in his 

 inaugural dissertation, and in the first volume of the " Archives fur 

 klinische Medicin," and in a case described by Griesinger, it ap- 

 peared that the patient did not learn to walk till late, and had al- 

 ways remained somewhat helpless. 



Of course the symptoms of the disease vary with the group of 

 muscles affected. In my patient, the disease started from the gluteal 

 muscles. As long as these were exclusively or chiefly affected, the 

 patient could only walk when, by aid of his arms, he had given his 

 head and shoulders a position where their point of equilibrium fell 

 behind the pelvis ; if this position was changed, he doubled forward 

 at the hip-joint. Now the disease affects all the muscles of his 

 lower extremities ; the patient cannot leave his bed, and can only 

 change his position by great exertion of his arms. 



I know of no cases of improvement or recovery except those of 

 Benedikt, who claims to have attained positive good results in three 

 cases by electricity. In my patients, who were treated for a long 

 time as advised by Benedict (by placing the copper pole on the 

 lower cervical ganglion, and applying the zinc pole along the side 



