A FAMILY WITH HEREDITARY (GENOTYPICAL) TREMOR 108 



corner of his mouth to one side, a tremor will easily set in on the right 

 side of his face. On the left side the trembling is less perceptible. The 

 disposition and movement of the tongue is normal. When thrusting 

 it out it trembles, sometimes nearly imperceptibly, sometimes rather 

 strongly. 



The upper extremities have normal mobility and sensibility. When 

 the patient is sleeping or entirely resting his arms on the bed no 

 tremor is to be found. But as soon as the arms are lifted from the 

 support there sets in an even, fine-waved tremor, which grows more 

 intense or large-waved when the patient is subjected to strain and exci- 

 tement. If the patient holds a half filled glass of water in his hand 

 or raises it to his mouth, the tremor increases so violently that the 

 contents are spilled out. The tremor, which has a frequency of 6 

 vibrations a second, is a little more intense in the right arm than in 

 the left. It extends over the whole arm. If the upper arm is supported 

 the tremor decreases in intensity. The handwriting is nearly illegible, 

 and the patient's »straight»- lines look very much like pulse-curves. 

 The electrical reaction is normal. The triceps, biceps, radiusperiosteal 

 and ulnaperiosteal reflexes exisft, and are almost the same on both 

 sides. The test with the lumbal puncture showed the spinal fluid to 

 be of normal pressure and of normal condition. Wassermann's test 

 in blood and in spinal fluid was negative.» 



Only 3 of Alfred N.'s 5 children are grown-up. One was still- 

 born, one died as infant of »teething convulsion». The 2 sons, both of 

 whom resemble their mother, have had no tremor. One of the sons 

 (J. M. N - 1892 'Vi, t 1910) died at the age of 18 years from heart- 

 disease and pneumonia. The daughter (Berta F. * 1890 7i), on 

 the contrary, resembles her father. She has the same manners 

 and temper as he, is hot-headed and passionate like him. The twit- 

 chings began when she was 2 — 3 years old and also bothered her at 

 school. When she gets agitated or eager for something the shakings 

 appear more distinctly in the arms also, and she sometimes feels shak- 

 ings in her legs as well. These complaints were worst when Berta 

 F. was 18 — 19 years old, at w'hich period she was very nervous. Upon 

 examination October 18th, 1919 there was not found, somatically, any- 

 thing to note save a fine-waved, even tremor in the hands, having 

 the frequency of 10 — 11 vibrations a second. Her ordinary handwriting 

 shows no signs of tremor, but when writing slowly her hand trembles. 

 Berta F. is married and has a child (U. F. * 1918 'Vi), but it is yet 



