Pseudo-hypertrophic muscular paralysis.

Mitchell, Silas Weir, 1829-1914.

Journal : Photographic review of medicine & surgery ; vol. 2., no. 1.

Philadelphia : J. B. Lippincott & Co., 1871-72.

Description : pp. 1-4, [1] pl. ; ill.: 1 photo. ; 24 cm.

Photograph : mounted albumen.

Subject : Primary Myopathy — Pseudohypertrophic Muscular Dystrophy ; Duchenne-Griesinger Disease.

Notes :

The lad himself is of a rather ruddy complexion, and has brown hair and blue-gray eyes. He has never had convulsions or any other grave acute malady. His tongue is clean, his appetite fair, his bowels regular, and his digestion good. The chest and heart are healthy, and the urine normal.

When stripped and examined, his posture and external appearances present some notable peculiarities. While standing, the shoulders are thrown back, the blades project, the belly is thrust forward, the feet four inches apart, and the spine curved forward in the dorso-lumbar region without lateral deviation. The attitude, which is characteristic of these cases, seems to be due to feebleness of the lower erector muscles of the spine, and is well illustrated in the photograph. Owing to the thrusting back of the shoulders, the arms hang in such a manner that a line carried across the dorsal spine touches the anterior face of the forearms. In the photograph, the attitude is chosen by the artist so as to exhibit the muscular developments of both legs, rather than the habitual posture of the lad when standing.

Above the waist, there is, with one exception, nothing remarkable about the muscular developments, which are such as belong to a person of his age. Both deltoid muscles are unusually large and hard, and are certainly much more conspicuous than they should be. They alone, of all the muscles of the upper extremities, seem to have shared in the pathological change which has affected the lower limbs.

Below the pelvic brim the muscles are seemingly developed enormously, so that the legs are those of an infant athlete surmounted by a body of ordinary dimensions. The photographs make needless any detailed description beyond the table of measurements which I append. — pp. 1-2.

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This is the first photograph of a case of Duchenne muscular dystrophy published in an America medical journal and the third such case to be identified and reported by an American physician. However, Mitchell only referenced one of the other two cases — a report written up by William Pepper, entitled Clinical lecture on a case of progressive muscular sclerosis and published in the June and July 1871 issues of the Philadelphia Medical Times. Curiously ignored by Mitchell was the first American study on Duchenne's disease titled, A Case of progressive muscular sclerosis, with a paper on the same," by Ingalls and Webber, published in the Boston medical and surgical journal (1870).

Mitchell's subject was an eight year-old boy, accompanied by his father to the neurologist's famous clinic at the Hospital for Deformities and for Nervous Diseases, located in Philadelphia. Physiological measurements were carefully taken but the father refused to let Mitchell use the Duchenne harpoon to pluck living tissue samples from his son's calf muscles. He did allow Mitchell to run his son through a series of electrical response tests, using up to 18 cells of a Stöhrer's 30 cell portable battery.

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