All these symptoms develop gently without commotion. There is no fever, the patient does not complain of pain, and nothing is present to give warning of the gravity of the affection. Duchenue in his first memoir drew attention to the fact that children suffering from this disease often give evidence of a weakened intellect, and as we have seen he was even led to regard pseudo-hypertrophic paralysis as dependent upon a cerebral affection.
All the other organs perform their functions well, and for a long time the patient presents every appearance of perfect health. Occa sionally the progress of the disease seems to be arrested for a time, but usually its march is resistless and sooner or later the child is condemned to absolute immobility. The atrophic process goes steadily on, and generally the patients succumb to some intercurrent disease the seat of which is most commonly in the lungs. This tuberculosis or broncho-pneumonia frequently terminates the pseudo hypertrophic paralysis. The disease reaches its greatest develop ment in from ten to eighteen years, and the sufferers seldom live be yond their twentieth year.
Diaplosis.—It would be hardly possible, given the symptomatol ogy and course of the disease which we have just considered, to con found psendo-hypertrophic paralysis with any other disease. I ought to note that there are cases of an atrophic nature from the com mencement; but, as I have already said, I separated the essential hypertrophic myopathies from the atrophic affections solely as a matter of convenience iu clinical descriptions. As a matter of fact these two forms frequently coincide and are confounded with each other, and the important point in a diagnostic sense. is to establish the primary inyopathic nature of the affection. Once this point is settled we may class the case according to its most prominent features among the pseudo-hypertrophies or among the atrophic forms which we shall study in a subsequent section.
We must not confound pseudo-hypertrophic myopathy with infan tile paralysis, paraplegia, or progressive muscular atrophy. This may easily be avoided by a study of the previous history and by carefully noting the progress of the disease from its inception. The apparent hypertrophy with diminution of strength is a very charac teristic feature. Thomsen's disease is sometimes accompanied by an increase in size of the members, but it presents in addition a most characteristic symptom, viz., the rigidity which is manifested at every attempt at voluntary movement and which relaxes gradually, permitting of the movement being made in a normal manner.
Treatmeid.—After what has been said concerning the prognosis of this affection we may conclude that there is little to be hoped for from treatment. It ought none the less, however, to be instituted at the earliest possible moment. The administration of tonics is indi cated, the special form being varied from time to time. We may give in succession cod-liver oil, cinchona, phosphate of lime, and arsenic. The child should live under the best hygienic conditions, and may with advantage be sent to the seashore. But the point to be most strongly insisted upon is electricity. Faradization has seemed to give some good results in these cases. It will be necessary to con tinue its employment for a very long time, for years even, care being taken, however, to discontinue the applications for a few weeks at a time at intervals of three or four months. Ladame of Geneva has pro posed a form of electrical massage by means of galvano-faradization, but this procedure, which combines the employment of faradic and of galvanic electricity, must be carried out with great caution, for it is very powerful in its effects and might give rise to injurious conse quences. It ought also to be applied only by physicians who are thoroughly skilled in the practical application of medical electricity.