The treatment of dystrophia myotonica with A.C.T.H.

Following the reports of Reese and Peters (1952) and of Shy and McEachem (1951) that A.C.T.H. was of benefit in the relief of dystrophia myotonica by increasing muscle strength, it was decided to try the effect of A.C.T.H. on a further group of patients. The results obtained form the basis of the present report. Case 1 is reported in detail, the remainder briefly. Case Reports Case 1.-Mr. S. is aged 35. In 1943, when serving in the Royal Marines, he noticed an inability to relax his grip. He was admitted to hospital where the diagnosis of dystrophia myotonica was made, and his discharge from the Marines followed. Since 1943 he has become bald and has experienced progressive difficulty in eating owing to stiffness of the muscles of mastication and of the tongue. At times there is such difficulty in moving the tongue and muscles of deglutition that he is unable to prevent a bolus of food lodging in the pharynx with consequent choking. This has been severe enough on at least three occasions for him to be admitted to various hospitals as an emergency. Saliva is difficult to swallow and speech has become monotonous so that people complain of difficulty in understanding him. Increasing weakness of the muscles of the neck makes it difficult for him to raise his head from a pillow and he has noticed that the neck has become much thinner in recent years. The difficulty in relaxing his grip has become more marked and he complains that when shaking hands he frequently hurts himself on jewelled rings. On walking, the left leg may suddenly stiffen from the hip to the toes causing him to fall over. The right leg has been similarly affected but less frequently. He has noticed that the left calf seems bigger than the right. There are no visual symptoms and respiration has never been interfered with. In spite of his disabilities he has been able to continue at his work as an artificial limb maker. There has been no decrease in libido and no impotence. He is married and has two daughters aged 7 and 6 years. He gave a past history of an appendicectomy in 1944. Both parents were of normal physique, but his paternal uncle was a very big, muscular man. Two brothers, aged 28 and 20, were killed in the war; both were of exceptional mnuscular development and very …