actly under the control
of the will. The unnatural movements of the hands corresponded to those
of the lower extremities, though they were more constant and active.
The fingers, including the thumbs, were usually widely separated and
extended, though they were sometimes slightly flexed. The hands were
continually in slow, methodic, quasi-rhythmic motion, never remaining
long in the same attitude. In grasping an object the palm of the hand
was used, it being difficult to approximate the digits. The
wrist-joints were also implicated, there being alternate flexion and
extension. In fact these odd contortions affected the entire limb from
the shoulder to the digital extremities. When standing or walking the
arms were held out horizontally, as if to maintain the equilibrium of
the body. The patient's general physical health was fairly good. She
frequently complained of headache, and when she was exceedingly
irritable and violent all the athetoid movements would be intensified.
Speech was jerky and disordered, which gave it a distinctive character.
The special senses seemed to be unimpaired, and the pupils were normal,
except when an epileptic attack came on. Death occurred in January,
1895, after an obstinate attack of status epilepticus." Paramyoclonus
multiplex is a condition of chronic muscular spasm affecting the trunk,
occasionally the muscles of the face, abdomen, or diaphragm. The
muscles affected are usually in the trunk and in the limbs, and not in
the toes and hand; occasionally the movements are tonic as well as
clonic; the degree of spasm varies greatly, and according to Gray may
sometimes be so violent as to throw the patient down or out of the
chair.

Saltatoric spasm is an extremely rare condition, first observed by
Bamberger in 1859. The calf, hip, knee, and back-muscles are affected
by clonic spasm, causing springing or jumping movements when the
patient attempts to stand. The disease is transient, and there are no
mental symptoms.

Progressive muscular atrophy has been observed as far back as
Hippocrates, but it is only in recent times that we have had any
definite knowledge of the subject. It is divided into four types, the
hand type (causing the griffin-or claw-hand, or the ape-hand); the
juvenile type (generally in the muscles of the shoulder and arm); the
facial type; and the peroneal type. Generalized progressive atrophy
leads to a condition that simulates the appearance of a "living
skeleton."