A practical treatise on medical diagnosis : for students and physicians . p, although dropping of one is seen from a few days to a fewweeks before that of the other. It develops gradually. At first thepatient cannot extend the fingers at the metacarpophalangeal thumb also suffers, and the weakness of the extensors is most THE DATA OBTAINED BY OBSERVATION. 129 marked on the ulnar side. At the beginning, if the first phalangesare passively straightened the distal phalanges can be extended bythe unaffected interossei muscles. The loss of power extends to thewrist. The extensors of the
A practical treatise on medical diagnosis : for students and physicians . p, although dropping of one is seen from a few days to a fewweeks before that of the other. It develops gradually. At first thepatient cannot extend the fingers at the metacarpophalangeal thumb also suffers, and the weakness of the extensors is most THE DATA OBTAINED BY OBSERVATION. 129 marked on the ulnar side. At the beginning, if the first phalangesare passively straightened the distal phalanges can be extended bythe unaffected interossei muscles. The loss of power extends to thewrist. The extensors of the wrist do not suffer equally. Those of theradial side are affected first. When the paralysis is complete the handdrops and cannot be brought to the level of the forearm. It may benoted that if the fingers are flexed passively the patient is able to closethe fist as long as the special extensors of the wrist retain power. If,however, the fingers are extended the wrist cannot be extended. Themuscles affected, therefore, are the common extensor of the fingers, the Fig. Photograph of a case of lead-paralysis affecting the extensor muscles. (Gkay. extensor indicis, the extensor of the phalanges of the thumb, and thoseof the wrist. The flexors of the fiugers are unaffected. The continuedover-flexion of the carpus produces slight displacement backward of thecarpal bones, and a prominence forms over the carpus and the dorsumof the hand, which alarms the patient but is of no consequence. Itis known as Gublers tumor. The Skin. The skin of the hand need not concern us, save asestimated in connection with the skin of the rest of the body. It issmooth or~rough, dry and harsh, moist and warm, under the same cir-cumstances that affect the skin generally. In rheumatoid arthritis ithas been particularly described as peculiar. Both the dorsal surfaceand the palm are moist and very soft, and the former dotted withfreckles. The swellings of the hand, inflammatory or cedematous, do not differfr
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