Analysis of 12 eases of ossification of muscle-tissue following traumatism. Careful study of these cases demon strated that at different tittles repeated htemorrhages had taken place in the various muscular layers, and that each of these lImmorrhages was followed by a, new formation of bone. The limmor rhage within the muscle, the following proliferation of connective tissue, and the further metaplasia into bone and cartil age held one to the other an inseparable etiological connection. Therefore, taking also into consideration the form and posi tion of the bony deposit, it must be ac cepted that the formation of bone does not come from the periosteum, but is of intramuscular origin. C. Raminstedt (Arehiv f. klin. Chin, D. GI, H. 1, moo).
Treatment. — Nothing yet employed has seemed to arrest the process of ossi fication.
1VIyasthenia Pseudoparalytica.
Myasthenia pseudoparalytica is a dis ease characterized by exacerbations of ex treme exhaustion of certain muscles and involving, among others, those of respi ration and deglutition.
Symptoms.—The onset is usually acute. The muscles of the face, those of degluti tion, and the external eye-muscles are often the first affected, the least con- . tinned effort in which these are utilized being followed by their complete exhaus tion and paresis. Strabismus, when the eye-muscles are involved, great difficulty , in deglutition, etc., may thus occur sud denly. The same exhaustion occurs after repeated electrical stimulation (Golly). After a period of rest the muscles grad ually recover some of their tone and their functions are resumed. In some cases persistent paralysis ensues. lIyasthenia sometimes proves fatal.
Pathology.-11Iyasthenia is thought to be a form of bulbar paralysis, the organic lesions affecting particularly the lower motor neurons. This view is hypothet ical, however, and is based mainly upon isolated symptoms observed in other dis orders, no clearly-defined local morbid changes having so far been discerned.
Treatment. —But few cases of rnyas thenia have so far been reported and no special therapeutic measures have been proposed.
The symptoms of myasthenia gravis are always rendered worse by bodily ex ercise and mental excitement. Henee, complete rest for mind and body should be the aim of treatment. The patients are from the very first in imminent dan ger of death, and their ndatives shonld he warned of this, otherwise the decep tive lulls in the symptoms may encour age fatal indiscretions. Frequent phys
ical examinations may have disastrous results. Meals should be small, easily assimilated, and given at short intervals. The use of the stomach-tube is danger ous, and should deglutition become im possible rectal feeding, is the only course to pursue. Stimnlant methods of treat ment by cold douching and faradism are absolut ely contra -indica ted. Ma ssage and galvanism have proved useless. None of the drugs hitherto employed appear really to influence the course of the disease. Strychnine has been used without benefit by Striimpell and Dr. Buzzard. Personal patient improved un der strychnine at first, lout subsequently relapsed while still taking it. Thyroid and suprarenal extract have proved also ineffectual. Tonics, such as arsenic and iron, have no specific action. Perhaps a. more extended trial of snprarenal extract might be worth making. Other organic extracts—such as cerebrin, myelin, didy min, and ovarian substance—may also conceivably be of service in a tox:einia which produces no visible changes in any part of the nervous system. Failing these medicaments, one can only hope that the toxin of my-asthenia gravis may be traced to its source, isolated, and its antidote fonnd in the chemical and phys iological laboratories. Morbid anatomy has thrown no light on the nature of the disease. L. G. Guthrie (Lancet, Feb. 1), 1901).
Myotonia Congenita (Thomsen's Dis ease).
A disorder in which certain groups of muscles, when voluntarily contracted, re main in a state of tonic cramp a short time, then gradually become relaxed.
Symptoms.—Wheo a patient suffering from myotonia grasps an object, the hand closes normally around the latter, but the grasp persists, notwithstanding his effort to open his hand. The cramp may be of brief duration and the patient almost im mediately begin to straighten his fingers, or it may last some lime, especially when the extremity is used after a period of rest. Continued use improves the mus .4' a \ • :11.'11', :Intl if the object is • . 1 di,. ern] times in suc • • .. L r•ition beLontes sometimes , 1.. I L. sant, phinomena may ap n patitnt staris to walk: .1 • pit forward slowly, it re -,.1 - -t..1.‘ In the extended position a sLL when it can be used ? -t n,-po.nt for the trunk by the \ • .f tilt Lxtclisors. while the other leg .•ncL.1. After a few steps have been n 1.ut little difficulty is experienced.