The second case, (Obs. 13) was a little girl six and a half years old. Paresis of the lower limbs began at the age of four and a half, and rapidly increased. The legs and thighs began to enlarge shortly after the first appearance of the paresis. Treatment began in about a year, and was conducted as in the first case, but in addition cod-liver oil and bitters were administered internally. Cure after a few months' treatment.
Duchenne refers the beneficial effect of the faradic current to a stimulating action on the vaso-motor nerves and capillary circulation, which he assumes to be paralyzed in this disease. The important point is to exert this stimulus before the hyperplasia of the connective tissue is far advanced.
Benedikt claims to have improved five cases by galvanization of the sympathetic. But the treatment was certainly based on an erroneous theory of the disease, and the alleged results must be received with caution.
Uhde88 claims to have arrested the progress of the disease in the gastrocnemii muscles by a double tenotomy operation performed for the relief of pes equinus. The patient was a boy of eleven, in whom the disease had begun at the age of five. At the time of observation all the muscles of the legs, as also the glutæi and sacro-lumbales, were hypertrophied. The feet could not be brought to the ground, owing to retraction of the calf-muscles: standing and walking were entirely impossible, and even the power to move the limbs in a recumbent position was very much limited. Faradization during a fortnight produced no effect. Then the tendons were cut, and faradization continued. In a month the patient could execute slight movements in bed; three weeks later he could walk along the ward; and four months after the operation he could walk alone and with the soles of the feet flat on the ground. The calves were softer than before, and diminished in circumference. But as the history stops here, it is possible that the two latter changes depended on a substitution of fatty infiltration for sclerosis. By this, moreover, the muscular fibre would be less compressed, and in its temporary liberation would for a while seem to regain part of its force. The last case of alleged recovery that we have seen is by Donkin.89
88 Langenbeck's Archiv für Chir., Bd. xvi., 1874.
89 Brit. Med. Journ., 1882, vol. i.
Gowers remarks90 that treatment must be directed rather against the effects of the morbid process than against the morbid process itself, which, as a primary error of development,91 must be, to a large extent, beyond our influence. As internal remedies, Gowers recommends arsenic, phosphorus, and cod-liver oil, noting that iron and strychnine seem to have no effect.
90 Loc. cit., p. 52.
91 Gowers says, "of the muscular tissue," but we have shown reasons why this should rather be sought in the blood-vessels of the part.
Faradization also, which is nearly always used, must have nearly always disappointed expectation, or more cures would be recorded. Systematic muscular exercises are recommended as the appropriate physiological stimulus to muscular growth. But in view of the fact that precisely those muscles are earliest and most profoundly affected which are exposed to the most strenuous influence of this stimulus, it is theoretically doubtful whether this advice be valuable.