590 



LEWELLYS F. BAKKEK 



wide apart and fully extended at all joints. As Oddo has emphasized, it 

 is well to be familiar with these different varieties of attitude that the 

 hand may assume, in order that errors in diagnosis may be avoided. 



At. the wrist joint the hand is slightly flexed, as a rule, upon the fore- 

 arm. In rare instances there may be extreme flexion at the wrist, so that 

 the hand and the forearm form a right angle (main botte). 



The forearm itself generally 

 occupies a position intermediate 

 between pronation and supi- 

 nation. 



About the elbow and the 

 shoulder there is, as a rule, no 

 contracture of the muscles, 

 though sometimes these -muscles 

 are also involved, in which event 

 the elbow is flexed and the fore- 

 arm is pronated and folded 

 across the chest, while the upper 

 arm is held in adduction close 

 to the side of the body. 



The lower extremities, less 

 often affected in adults, are 

 quite commonly involved in 

 children. When the cramps in- 

 volve these parts (pedal spasm), 

 there is marked plantar flexion 

 of the feet, while the sole of the 

 foot is turned niedialward (po- 

 sition of talipes equinovarus). 

 This plantar flexion at the ankle 

 joint is due to spasm of the M. 

 gastrocnemius a n d the M. 

 sole-us, innervated by the N. 

 tibialis, whereas the supination 

 of the foot, that is to say its 

 adduction with elevation of its 

 medial margin, is 1 due to con- 

 traction of the M. tibialis posticus, innervated also by the !N". tibialis. 

 The dorsum of the foot becomes convex, and the sole of the foot concave, 

 due to strong adduction of the metatarsal bones, consequent upon con- 

 traction of the Mm. intcrossei volares, which are innervated by the N. 

 tibialis. The toes, too, arc strongly flexed and adducted, owing to con- 

 traction of the Mm. interossei and the lumbricales. The great toe, 

 loo, is usually strongly adductcd (M. adductor hallucis), sometimes so 



].-} o Tetania persist ens (9 months old 

 child) ; hands and feet in typical claw position. 

 (After .1 Ibrahim, in Peer's Lehrlmch der 

 Kinderheilknnde. .Jena. 1!)12. ) 



