. Essentials of diagnosis. Arranged in the form of questions and answers prepared especially for students of medicine . n of the face is fixed and immo-bile. The shoulders are bent forward, giving rise to the phe-nomena of propulsion—a tendency to run forward. Occasionallythere is retropulsion, or there may be a tendency to lateralmovement. The hands assume a peculiar, semi-flexed attitude,the fingers performing movements as if rolling a small objectbetween their tips ; or the fingers are held as if grasping a voice is monotonous ; words are uttered rapidly, with atendency to confluenc
. Essentials of diagnosis. Arranged in the form of questions and answers prepared especially for students of medicine . n of the face is fixed and immo-bile. The shoulders are bent forward, giving rise to the phe-nomena of propulsion—a tendency to run forward. Occasionallythere is retropulsion, or there may be a tendency to lateralmovement. The hands assume a peculiar, semi-flexed attitude,the fingers performing movements as if rolling a small objectbetween their tips ; or the fingers are held as if grasping a voice is monotonous ; words are uttered rapidly, with atendency to confluence of syllables. The reflexes are usuallyunaltered ; exceptionally the knee-jerks are exaggerated and anankle-clonus can be elicited. A sensation of abnormal heat,sometimes with perspiration, is often present. PARALYSIS AGITANS. 307 What are the differential features between paralysis agitansand cerebro-spinal sclerosis ? The diagnosis between tliese two conditions, ordinarily simple,may under some circumstances be extremely difficult. Thetremor of cerebro-spinal sclerosis is coarse and irregular, and is Fig. ^^:--.^;l Paralysis agitans. (After St. Leger.) induced and aggravated by voluntary effort, by emotion and byobservation ; that of paralysis agitans is fine and regular, andis constant, at least during the waking hours. In cerebro-spinalsclerosis, the head participates in the movements ; in paralysisagitans, on the contrary, the face is fixed, immobile, expression-less. Paralysis agitans does not present the slow, scanningspeech and nystagmus of multiple sclerosis ; while the latter doesnot present the tendency to forward or backward or even lateralmovement of the former. The characteristic attitude of thehand, as if holding a pen in writing, or as if rolling pills betweenthe fingers, seen in paralysis agitans, is not seen in multiple scle-rosis. 308 ESSENTIALS OF DIAGNOSIS. Spinal Hemorrhage. What are the causes of hemorrhage into the spinal cord? Spinal hemorrhage
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