. The Journal of nervous and mental disease. e patient had a small depressionin the median line on back of neck out of which grew a small tuftof hair. Although the upper extremities seemed to develop nor-mally the patient never was able to use the hands as well as the ordi- SPIXA BIFIDA OCCULTA IX CERVICAL REGIOX 203 nary child. She could sweep, carry or push objects of weight andplay ordinary games in which finer movements of the hands werenot involved. She was not clumsy except in buttoning the clothing,in tying laces, in doing fancy work, etc., but in these and other ac-tivities in which fi
. The Journal of nervous and mental disease. e patient had a small depressionin the median line on back of neck out of which grew a small tuftof hair. Although the upper extremities seemed to develop nor-mally the patient never was able to use the hands as well as the ordi- SPIXA BIFIDA OCCULTA IX CERVICAL REGIOX 203 nary child. She could sweep, carry or push objects of weight andplay ordinary games in which finer movements of the hands werenot involved. She was not clumsy except in buttoning the clothing,in tying laces, in doing fancy work, etc., but in these and other ac-tivities in which finer movements were necessary she was so slowas to preclude the doing of any but necessary tasks. She dressedand undressed herself, but did so slowly and was aided wheneverspeed was desired. Piano playing was attempted but quicklydropped as being too difficult. Examination.—The girl was of moderate height for age andwell nourished. She was slightly inclined to obesity. The tonsilswere large and cryptic. The cardiac dulness extended about a. Case I. X. Diagram sketched from X-raj plate showing cleft in thirdcervical vertebra. centimeter to left of mid clavicular line and there was heard a softblowing systolic murmur over apex; not transmitted. There wereno other evidences suggestive of visceral disease. On the posterior surface of the neck in median line between thefourth and fifth cervical spines was found a depression in skinabout an eighth of an inch in depth, out of which a small tuft ofhair half an inch in length was growing. Skiagraph showed no defect in the fourth or fifth cervical ver-tebrae but a cleft in the arch of the third. Both hands were sufficiently well developed that to casual in-spection no abnormality was noticed. On examination, however,it was noted that the fingers were hyperextensible. This was moremarked on left side; occasionally the fingers on this side were 204 SAMUEL N. CLARK. slightly hyperextended even at rest. This was a little moremarked in littl
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