The  Steppage  Qait. — In  some  cases  of  peripheral  neuritb  the
paralysis  of  the  extensors  of  the  feet  causes  a  peculiar  modification  in
progression.  In  stepping  forward  the  knee  is  strongly  flexed  and  the  foot
sharply  advanced  in  order  that  the  dragging  toes  may  be  lifted  from  the
ground;  the  heel  is  brought  down  first  and  the  appearance  is  that  of  a
person  stepping  over  obstructions.
The  waddlins^  gait  occurs  in  pseudohypertrophic  muscular  paralysis
and  is  not  less  characteristic  than  the  attitude  in  this  disease.  In  con-
sequence of  the  lordosis  the  shoulders  are  thrust  back  and  the  belly
forward,  the  legs  are  separated,  the  feet  raised  slowly  with  the  toes  drop-
ping, the  centre  of  gravity  being  alternately  shifted  over  the  foot  upon
which  the  patient  throws  his  weight.  The  manner  in  which  the  child,  after
l3ring  down  upon  the  floor,  gets  up  is  especially  characteristic.  He  rolls
over  upon  the  abdomen,  gets  upon  all  fours,  and  first  extends  the  arms,
then  the  legs.  The  hands  are  next  drawn  toward  the  legs  until  he  can
grasp  one  knee  with  the  corresponding  hand.    He  pushes  himself  up  until

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418  MEDICAL  DIAGNOSIS.
the  other  knee  can  be  grasped  and  assumes  the  erect  posture  by  gradually
raising  the  point  of  support  of  the  hand  upon  the  thigh.  Late  in  the  diaeaae,
when  the  atrophy  involves  the  muscles  of  the  upper  extremities,  it  becomeB
impossible  to  rise.
The  ataxic  gait  is  that  of  incoordination  of  the  lower  extremities.
It  is  observed  in  its  most  typical  form  in  tabes  dorsalis.  In  stepping  the
foot  is  raised  higher  than  usual  with  a  jerk  and  rapidly  advanced  with
an  awkward  and  irregular  movement,  the  toes  slightly  drooping.  It  is
then  brought  down  with  an  abrupt  stamp  upon  the  heel  or  the  entire  sole.
