PSEUDO-HYPEKTKOPHIC   PARALYSIS.
389


The  sufferer  uses  surroinidiiii:-  objects  us  a  means  of  rising,  drawinir  the
body  upward  by  tlie  hands.  When  unable  to  reacli  such  assistance  the
steps  which  are  taken  to  rise  are  thus  described  by  Growers :  "  If  laid,
for  example,  on  his  back  upon  the  tioor  and  told  to  rise,  he  would  first
with  great  difficulty  turn  on  his  face;  he  would  next  get  on  his  knees,
his  head  being  almost  between  his  thighs;  from  this  position  he  would
gradually  extend  himself,  so  that  he  stands  upon  his  feet  and  hands  with
all  his  limbs  extended ;  finally  he  would  extend  the  h?p-joint  by  grasping
the  thigh  with  the  hand,  and  pushing  up  the  bodj',  as   it    were,  b}'  the


Fig.  112. — Side  View  of  Attitude   of  Pseudo-
hypertrophic Paralysis.      (Duchenne. )


Fig.  113. — Rear  View  of  Attitude  of  Pseudo-
hypertrophic Paralysis.     (Duchenne.)


arm/'  This  movement  of  "climbing  up  the  thighs,"  as  it  has  been
termed,  is  an  indication  of  weakness  in  the  muscles  which  straighten
the  knee,  and  also  those  which  extend  the  trunk  upon  the  thigh,— the
extensors  of  the  hip-joint.     (See  Figs.  52  and  53.)

The  (jait  of  these  iiatients  is  associated  with  an  oscillation  of  the
body  from  side  to  side,  or  a  waddling  movement.  The  advance  made  at
each  step  is  very  small,  and  a  difficulty  seems  to  be  experienced  in
flexing  the  thigh  upon  the  abdomen.
The  vmscles  of  the  calf  exhibit  early  a  firmness  and  increase  in  size
which  is  not  proportionate  to  their  motor  force, — as  that  is  far  below


390  LECTURES   OX   NERVOUS   DISEASES.
normal.  Soon  they  become  excessively  developed,  as  do  also  those  of
the  buttock,  while  the  other  muscles  of  the  leg  commonly  grow  smaller
from  atrophic  changes.
