11-e of the lower limbs after a t.„il L f rcst may thus become a source dallItr. the patient falling heavily, to sudden cramp of the muscles 17-n which he depends for the mainte t...,,.:,e f the erect position. Excitement, and oleruse also predispose the in..isclis to tonic cramp.
muscles of the arms and legs are the only ones affected. The mus k-. cf d« glutition, the sphincters, and in-triated muscles are never in \ i•L.d: the facial. laryngeal, or ocular r. r .y. In a case reported by Ballet and M.rie the eyes became fixed when turned .p..iard and their position could only be --red !radually. The patients are usu _.1..- str. ng. though not in proportion to , • mu-cular development, which is often J., ',Jai. Distinct hypertrophy is some • JP observed. The disease gives rise i_tt'e physical suffering, but mental •. and a tendency to melancholia b..en ol.served in a small proportion -.---. Erb has called attention to the f that the electrical reactions of the 1. . were characteristic: their me Irritation is increased. but, in -., f contracting suddenly, they only -lowly, the act being followed by a fr.....nged tonic after-contraction. While ernstant galvanic current is being d it gives rise to rhythmical wave "- -e cintractions of the bodv of the mus cle, the "Ilow- going from cathode to anode.
The affection, which begins early in life, usually continues uninterruptedly until death from an intercurrent der. Some cases, however, are attended by exacerbations and remissions; in a very small proportion of cases the im provement is permanent. Etiology.—Myotonia is hereditary in the majority of cases. While other forms.
of spasm simulate it, the typical disease has always occurred in family groups.
In the family of Dr. Thomsen, who first described the disease and who was self a sufferer, myotonia was traced through five generations. Fright and
overuse of the muscles seem to act as predisposing factors. It is more quently observed in males than females.
The disease is rarely observed in the United States.
Case of a man in whose family Thom sen's disease, as usual, was hereditary. The first symptoms showed themselves at the age of 6 years and were present at the onset in winter only, the patient being in good health during the sum mer. O. Hollmann (Schmidt's Jahrh., Jan., '95).
The initial lesion is muscular hyper plasia. Hypertrophy is found mostly in those muscles which perform the greatest amount of work; it is of functional ori gin, with integrity of the nervous sys tem. Dejerine and Sottas (Le Bull. Med., June 5, '95).
Case of Thomsen's disease in a patient 23 years old, and who had not been affected by the trouble until lie was 13 years of age; hence there is no propriety in calling such a case "myotonia con genita." Cases divided into three classes as follows: (1) myotonia congenita, (2) myotonia aequisita, and (3) myotonia transitoria. G. W. Jacoby (Med. News, Jan. 1, '93).
Pathology.—The exact pathology of myotonia may be said to be unknown.
Hypertrophy of the muscle-fibres—some being double the normal size—with a multiplication of nuclei affecting the en tire muscular system, except the myo cardium, were observed by Dejerine and Sottas. The peripheral nerves and the spinal cord showed no morbid change.
Treatment.—Gymnastics or systematic stimulation of the muscles by co-ordi nated exercises, frictions with oil, and massage may be tried with some hope of mitigating the intensity of the mani festations. Marriage proved of great value in the case of a young female.