PARATHYROID GLANDS 



589 



of tonic contractions by the upper extremities, so well described by 

 Trousseau, is very characteristic. The fingers are held straight, or nearly 

 straight, and a little flexed at the metacarpophalangeal joints. The four 

 fingers are crowded together by adduction, so as to form a cone. The 

 thumb, too, is strongly adducted and opposed, often so much so as to be 

 turned into the cavity formed by the adduction of the other fingers, or 

 into the palm. Even the metacarpal bones are somewhat adducted, so 

 that the dorsum of the hand presents a convex surface and the palm be- 

 comes scarcely visible. The whole effect is that of a cone-shaped, or 

 pyriform, hand. It is the shape of hand assumed by the obstetrician 

 when he goes to pass his hand through the vagina into the cervix of the 



Fig. 1. Typical position of the hand in an attack of tetany. This is the so- 

 called "obstetrical hand." The same appearance, due to pressure upon the upper arm, 

 is known as Trousseau's phenomenon. (After E. Fhleps, in Lewandowsky's "Handb. d. 

 Neurol.," published by J. Springer, Berlin.) 



uterus in the parturient woman; hence the name "obstetrical hand," or 

 main de V 'accoucheur,, given to it by Trousseau (Fig. 1). 



Other attitudes of the hand are met with in tetany, but they are less 

 common. Thus, sometimes, the thumb, instead of being opposed and 

 markedly adducted, so as to be turned into the palm, is extended, so as to 

 remain in line with the four fingers, the hand as a whole being in the 

 position adopted when one presses the hand flat upon a sheet of paper; 

 hence the French term for this attitude, main en presse papier. In other 

 instances the fingers may be flexed at all their joints through spasm of 

 the long flexor muscles; the fist is then tightly closed and the con- 

 tracture may be so marked that the finger nails are driven into the 

 skin, so as to cause necrosis (main de I'Jiemiplegique contracture) . In 

 still other instances a bird claw position (main en griffe) of the hand is 

 assumed, due to spasm chiefly in the interossei and lumbricales (Fig. 2). 

 In certain rare examples of tetany spasm the fingers may even be spread 



