Nervous and mental diseases . xed or ex-tended at the wrist, but the fingers are always held more or less inflexion. A position similar to that of holding a pen is common, or thehand may be partially closed. The digits frequently deviate to theulnar side of the hand, as in rheumatoid conditions, and these may alsobe present. In the lower extremity the stiffness is less marked, but inadvanced cases causes a knee-sprung attitude and gait. The gait of Parkinsonians is strikingly peculiar. When the patientrises from the chair, he hesitates a moment as if to take aim, and startsahead in a direct li
Nervous and mental diseases . xed or ex-tended at the wrist, but the fingers are always held more or less inflexion. A position similar to that of holding a pen is common, or thehand may be partially closed. The digits frequently deviate to theulnar side of the hand, as in rheumatoid conditions, and these may alsobe present. In the lower extremity the stiffness is less marked, but inadvanced cases causes a knee-sprung attitude and gait. The gait of Parkinsonians is strikingly peculiar. When the patientrises from the chair, he hesitates a moment as if to take aim, and startsahead in a direct line, his laggard legs trotting to keep up with the for-ward-leaning body. In some instances the patient is strongly impelledforward, and can only arrest himself by running into objects or may or may not be an actual tendency to fall forward, or propul-sion, but in some cases, if the body be started backward, sideways, orforward by a push, the direction is maintained for a few or many steps,. $4 4% -fWaAClrrf:.. Fig. 238.—Handwriting in Parkinsons disease, with former style below. giving rise to the terms lateropulsion and retropulsion, and these mayoccur spontaneously on getting up or in attempting to stop while ad-vancing. As described by Stewart,2 in advanced cases the method ofgetting into bed is characteristic. The patient climbs on to the bed,stands up, and, bending down very slowly, grasps the rail at the foot-board. Holding firmly to the bedstead he slowly sits down and thenfalls or rolls backward into the recumbent posture. 1 Bruns, Neurolog. Centralbl., Nov. 1, 1904. 2 Lancet, Nov. 12, 1898. 570 NEUBOSES. The trembling- in shaking palsy may appear after rigidity has de-veloped or at the same time. It usually commences in one hand andarm and then invades the lower extremity, subsequently appearing inthe opposite arm and finally in the opposite leg. In some cases it isbilateral from the start, but commonly it is more marked on one sidethan on the other,
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