. Physical diagnosis . he Wrists in Hypertrophic Pulmonary Osteo-arthropathy. (v. Ziemssens Atlas.) Most of these tremors need no comment. The intention tremorof multiple sclerosis (sometimes seen also in hysteria) is exaggeratedinto coarse shaking movements when the patient tries to pick up a pin,drink a glass of water, or do any other act calling for the volitionalcoordination of the small hand muscles. In the presence of such atremor we should look for nystagmus (see above, page 16), a spasticgait (see page 473), and a slow, staccato speech. This group of symp-toms suggests multiple (or ins
. Physical diagnosis . he Wrists in Hypertrophic Pulmonary Osteo-arthropathy. (v. Ziemssens Atlas.) Most of these tremors need no comment. The intention tremorof multiple sclerosis (sometimes seen also in hysteria) is exaggeratedinto coarse shaking movements when the patient tries to pick up a pin,drink a glass of water, or do any other act calling for the volitionalcoordination of the small hand muscles. In the presence of such atremor we should look for nystagmus (see above, page 16), a spasticgait (see page 473), and a slow, staccato speech. This group of symp-toms suggests multiple (or insular) sclerosis. 46 PHYSICAL DIAGNOSIS In direct contrast with this is the pill-rolling tremor of paralysisagitans, which usually ceases during voluntary movements. The thumband forefinger are near or touch one another, and move as if they wererolling a bread-pill. This tremor is usually associated with an immov-able, expressionless face, a stiffened neck and back, and a peculiarattitude and gait (see below, page 474)..
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