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Tonic Contraction of the Extremities

muscles, children, time, rigid, noticed and flexed

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contraction of the extremities, or tetany, is sometimes met with in young children, most commonly in the subjects of reflex convulsions or laryngismus stridulus. The contraction occupies the muscles of the limbs, especially those of the hands and feet, and may be continuous, remittent, or intermittent.

Causation.—Tonic contraction appears to be one of the many forms of reflex disturbance to which rickety and excitable children are so peculiarly prone. The disorder rarely attacks a sturdy subject. It is most commonly met with in young patients whose nutrition is imperfect either from in judicious management or natural delicacy of constitution, and appears to be predisposed to or excited by digestive derangements and other forms of irritation. Thus a little girl of five years old, who had recovered under my own observation from tubercular peritonitis, but had remained very delicate and liable to gastric and intestinal troubles, one day swallowed a part of an orange. She was seized shortly afterwards with severe pains in the belly, and passed a few loose, unhealthy motions. At the same time the fingers became firmly clenched, with the thumbs inverted and the wrists flexed. In this state she remained for forty-eight hours, in spite of active treatment by injections and laxatives. At the end of this time a large enema brought away a mass of orange pulp. The child was at once re lieved, and the rigid contractions of the muscles ceased from that moment. Similar instances have been recorded in which a constipated state of the bowels has been a cause of the phenomenon, and other sources of dis turbance and excitement, such as pleurisy, pneumonia, cliarrhcea, intestinal worms, the irritation of uric acid calculi, and teething have been quoted as exciting causes of this painful affection. The age at which children are most liable to be attacked is between the first and third year. The disor der is said sometimes to affect young girls shortly before puberty, and in such cases is attributed du the continent of Europe, where tetany seems to be more common than in this country, to the influence of cold and damp.

Symptonis.—A child who has been for some time in a weakly state, and is, perhaps, in the majority of cases, the subject of mild rickets, all at once cries with pain in the extremities, and it is noticed that these parts are contracted. Often the contraction is found to succeed to a fit of convul sions or an attack of laryngeal spasm ; but it persists after these are at an end. The muscular spasm may affect both bands and feet, or be noticed first in the fingers, and spread thence to the hand and wrist, the ankle and the toes. When fully developed the hand is found to be flexed at the wrist, and the thumb to be firmly inverted into the palm. The fingers may be rigidly clenched upon the thumb, or slightly separated and perfectly straight except for some slight flexing of the last joint. The ankles are often extended and the toes firmly flexed. In a few cases redness and swelling in the neighbourhood of the joints have been noticed. The con traction in most cases seems to be painful. Infants cry repeatedly, and older children complain of pains shooting along the course of the. nerves. The muscles are in a state of rigid contraction. In pronounced cases, not only can the muscles of the leg, such as the gastrocnemii and peroneii, and of the forearm be felt to be firm, but the act of manipulating them in creases their tendency to become rigid. Pressure may even induce tonic contractions in muscles otherwise free from rigidity, such as the pectorals, the muscles of the neck, and those of the abdomen. In a severe case re corded by Dr. Cheadle—in a boy two years old—even the muscles of the face were in a state of abnormal excitability, for irritation of the skin just in front of the left parotid region caused twitching of the orbicularis pal pebraruin, the levator alp nasi, and the levator anguli oris. The same phenomenon was also seen, although to a less degree, on the right side of the face. There was, in addition, some difficulty in swallowing, especially when liquids were taken.

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