116 PHYSICAL EXPRESSION. 



important to note whether the finer or coarser 

 movements be the most affected ; the amount of 

 involuntary movement, and the power of voluntary 

 act that is left. 



3. Hemiplegic varieties are common ; the least 

 mobile side may be much weakened, though not 

 much moved. 



4. The face. Varieties in this group of muscles 

 have been discussed. 



5. The soft palate may present marked move- 

 ments of an irregular twitching kind, the levator- 

 palati muscles working distinctly. I do not refer 

 here to the dragging of the palate by the choreic 

 twitchings of the tongue, but to the primary twitch- 

 ing of the palatine muscles. In some cases the 

 levators are distinctly seen twitching upwards. 

 This symptom is often absent in chorea, and when 

 seen, I have observed that it has usually passed off 

 early. 



6. The tongue may be jerked in and out. When 

 protruded, it may present much movement, but 

 still be kept out a fairly long time. 



7. Eyes. Upper eyelids often strongly retracted. 

 Eyeballs often much moved. 



8. The head in the active stage is often moved 

 much. During convalescence, and when the active 

 movements have passed off, a lolling of the head 

 to one side is common; i.e. inclination with rota- 

 tion to the same side, combined with slight flexion. 



9. The spinal muscles and trunk are often affected. 

 The child often balances itself very ill, throwing 

 the scapular and upper dorsal region too far back, 



