PARATHYROID GLANDS 591 



strongly as to be turned in under the other toes, much as the thumb 

 is. turned into the palm of the hand. In children this attitude of the 

 foot is very much like that of a ballet dancer, walking on her toes 

 (demarche des dameuses). Less commonly a valgus position of the foot 

 is assumed (spasm of the Mm. peronei), or the foot may be held rigidly 

 in a fairly normal position. It is, however, a striking fact that the con- 

 tractions in the lower extremity predominantly concern, as a rule, the 

 muscles innervated by the N. tibialis, just as those in the upper extremity 

 predominantly concern the muscles innervated by the ~N. ulnaris. 



The knees are generally held in rigid extension when the lower extrem- 

 ities are involved; rarely, they are flexed. In the former instance, the 

 spasm is in the M. quadriceps femoris; in the latter, more rare, it is 

 in the flexor muscles at the back of the thigh. There may also be con- 

 tracture of the adductors of the thighs, so that the limbs are held close 

 together, or the thighs may even be crossed (scissors position). Occasion- 

 ally the thighs are flexed at the hips (spasm of the M. iliacus and the 

 M. psoas), but this attitude is rare. 



It is interesting to note that, both in the lower and the upper ex- 

 tremities, the contractures in tetany are more marked distalwards and less 

 marked proximal wards. Thus, in the upper extremities, the shoulders 

 and elbows are often free, whereas the wrist, hand and digits are held 

 rigid; and, in the lower extremities, the hip joints are much less often 

 affected than are the knees, ankles and toes. The greatest rigidity seems 

 to be in the small muscles of the hand and of the foot; that is, as has 

 above been pointed out, in the distribution of the N". ulnaris in the upper 

 extremity and in the distribution of the N. tibialis in the lower extremity. 



In an analysis of 122 cases, v. Frankl-Hochwart (a) (b) observed mus- 

 cle spasm in the lower extremities in 70 instances. Spasmodic contractures 

 in the feet (pedal. spasms) occur but rarely alone, but are nearly always 

 associated with spasms in the hands and arms (carpal spasms), the com- 

 bined attitudes thus forming the well known carpopedal spasms of tetany. 



In the trunk, the thoracic muscles are sometimes involved in the spasms 

 of tetany, especially the M. pectoralis major and the M. trapezius. Even 

 the abdominal muscles may be concerned in the contractures, the Mm. 

 recti standing out sometimes like stiff bands under the skin on the front 

 of the abdomen. Danger of asphyxia may arise, if the diaphragm undergo 

 spasm along with spasm of the respiratory muscles of the trunk and 

 abdomen. 



The whole trunk may be hyperextended (opisthotonos) , as in tetanus, 

 due to spasm of the Mm. ileocostales dorsi et lumborum ; less often it 

 is in flexion (emprosthotonos) ; still more rarely, it is observed in lateral 

 flexion, due to spasm of the M. quadratus lumborum. 



When the muscles of the neck are involved, the head is usually drawn 

 backward, and the neck more or less excavated, owing to spasm of the 



