atrophic  form.  The  face  is  never  affected  in  pseudo-hypertrophy  as  it  is
sometimes  in  idiopathic  atrophy.  If  more  than  one  member  of  a  family  is
affected,  some  of  the  sufferers  will  usually  present  characteristic  symptoms
if  the  malady  is  of  the  pseudo-hypertrophic  type,  for  it  is  remarkable  with
what  constancy  the  two  forms  remain  distinct  in  the  various  families  (see
p.  394).  If  an  excised  fragment  presents  no  increase  of  interstitial  tissue,
pseudo-hypertrophy  is  excluded,  but  the  presence,  of  some  fibrous  tissue
between  the  muscular  fibres  does  not  prove  that  the  case  is  of  the  pseudo-
hypertrophic type,  since  some  muscles  may  present  this  change  in  a  case  of
the  atrophic  form.
Prognosis. — In  any  case  of  pseudo-hypertrophic  paralysis  the  prognosis
is  most  grave.  It  is  almost  certain  that  each  year  will  bring  increasing
disability,  and  that  the  patient  will  not  reach  adult  life.  It  is  only  when
the  disease  develops  late,  and  the  symptoms  do  not  become  considerable
until  after  twenty  years  of  age,  that  there  is  a  possibility  that  the  disease  may
not  attain  its  ultimate  degree,  but  even  in  such  cases  this  hope  is  seldom
realized.  In  any  case,  and  at  any  age,  it  is  unlikely  that  the  patient  will
live  more  than  seven  years  after  the  power  of  standing  is  lost.
