FINGER-TWITCHING. 125 



for four months ; it is submitted that probably the 

 same nerve-centres were affected in the greater and 

 lesser illness, but in a different degree. 



The varieties of finger-twitching have been 

 referred to. They may be described as 



(1) Flexor-extensor; the primary movement being 

 that of flexion, followed by a secondary extensor 

 movement. This may be seen in a variety of cases, 

 and in particular is seen in what is called " picking 

 the bedclothes " in the typhoid state preceding fully 

 developed coma. 



(2) Extensor-flexor; the primary movement being 

 that of extension, followed by a secondary flexor 

 movement. This is common in the slighter forms 

 of chorea and in nervous children; such twitches 

 usually constitute the subsultus tendinum so indica- 

 tive of exhaustion in the course of typhoid fever. 



(3) Abductor-adductor twitches ; the movements 

 consisting in lateral separations of the fingers, 

 followed by their being drawn together again. 



As to " finger- twitching/' the " nervous hand," and 

 " the relaxed orbicularis oculi," the following statis- 

 tics are from an analysis of thirty-four cases from 

 my note-books of the East London Children's 

 Hospital : 



Finger-twitcliings in 19. Twitchings alone . . in 8 cases. 

 With the nervous hand 8 

 With relaxed orbicularis ,, 3 



The nervous hand in 19 Nervous hand alone . 7 

 With twitchings . . 8 

 With relaxed orbicularis ., . 4 



19 



