. A manual of diseases of the nervous system. ding to their seat, and vary in distinctness, conspicuousness, andthe ease with which they are produced according to the mechanicalconditions of the muscles and their attachments. The first of these is the jerk of the leg which occurs when thepatellar tendon is tapped. It has been called the knee-phenomenon KEFLEX. 21 by Westphal, the patellar tendon-reflex by Erb, the knee-jerk by myself. To obtain the jerk, the knee must be flexed so that thequadriceps f emoris is gently extended. If then the patellar tendon isstruck, the quadriceps contracts, an
. A manual of diseases of the nervous system. ding to their seat, and vary in distinctness, conspicuousness, andthe ease with which they are produced according to the mechanicalconditions of the muscles and their attachments. The first of these is the jerk of the leg which occurs when thepatellar tendon is tapped. It has been called the knee-phenomenon KEFLEX. 21 by Westphal, the patellar tendon-reflex by Erb, the knee-jerk by myself. To obtain the jerk, the knee must be flexed so that thequadriceps f emoris is gently extended. If then the patellar tendon isstruck, the quadriceps contracts, and the lower leg is jerked forwardif free to move. The blow is given over the space above the tibiawhere the tendon can yield, so that there is a sudden increase in thetension of the muscle. The most convenient position is with the kneeto be tested flexed nearly, but not quite, at a right angle, by beingplaced over the other knee as the person sits (Fig. 1). But if the legto be tested is stout, its tension in this position may be too great to. Fig. 1.—The Knee dotted line indicates the movementwhich follows the blow on the patellartendon. Fig. 2.—The of obtaining it when itis not readily pioduced in theordinary way. permit of any movement. In such case the observer may place his armbeneath the patients thigh, just above the knee, and rest his hand onthe patients other knee (Fig. 2). Muscular relaxation is sometimesmore readily obtained when the legs hang vertically ; or the foot mayrest on the floor, and the contraction be felt by the hand placed on themuscle; the effect of the recoil and of the muscular contraction mustthen be carefully distinguished. If the bent fingers of each hand arehooked together, the hands pulled strongly, and the eyes closed, themovement is increased in degree— reinforcement, it has been termed.*It is essential that the flexors also should be free from voluntary con-traction. This contraction may be ascertained by feelin
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