Nervous and mental diseases . 36 NERVOUS AND MENTAL DISEASES. of the great gluteal muscle, when the patient is erect or prone, are followedby contractions in corresponding segments of that muscle, and a tap nearthe anterior superior spinous process starts the tensor facioe latoe knee-jerk, or patellar reflex, being easily examined and frequently modi-fied by disease, is one of the most important of the muscle reflexes. Itis ehcited generally by having the patient cross one knee over the otherwhile sitting. The under hmb, with the knee at a right angle, shouldsupport the upper, whic
Nervous and mental diseases . 36 NERVOUS AND MENTAL DISEASES. of the great gluteal muscle, when the patient is erect or prone, are followedby contractions in corresponding segments of that muscle, and a tap nearthe anterior superior spinous process starts the tensor facioe latoe knee-jerk, or patellar reflex, being easily examined and frequently modi-fied by disease, is one of the most important of the muscle reflexes. Itis ehcited generally by having the patient cross one knee over the otherwhile sitting. The under hmb, with the knee at a right angle, shouldsupport the upper, which gently rests over it with all muscles relaxed. Asmart, quick blow with an object of some ounces weight, as with the backof a thin book, the ulnar border of the hand, or, best of all, with a properpercussion hammer, upon the patellar ligament or just above the patella,is followed by a contraction of the anterior thigh muscles, causing thesuspended foot to move forward an inch or two. A percussion Lammer. y Fig. 7.—Method of eliciting ankle-clonus. at least twice the weight of the one usually employed in chest examina-tions should be used in doubtful cases and is valuable in routine prac-tice. If the patient is in bed, the limb to be examined may be lightlyplaced over its extended fellow, crossing it at the knee, and then theblow employed, or with the patient on his side, the knees partly flexed,the same thing may be done. When difiiculty is encountered in secur-ing this response, it is to be remembered that unless the muscles arefully relaxed the patient may inhibit the phenomenon, or that it maybe so slight as to escape attention. If the patient be placed on ahigh chair or on the edge of a table so that the legs are pendent, and atthe same time his attention be diverted, the jerk may usually at oncebe shown. It can also be reinforced, as described by Jendrassik, byhaving the patient grasp some object vigorously with his hands, orby merely clenching his hands at the time the
Size: 1697px × 1472px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, booksubjectmentalillness, booksubjectnervoussys
