. Medical diagnosis for the student and practitioner. d jerk of the leg and foot or visible contraction of the musclevaries greatly in health and may be markedly increased in certain conditionsof impaired nutrition associated with nervous instability, hysteria, tetanus, * Tendon Reflexes. (Deep reflexes.) It will be noted that all of the tendon reflexesrequire that the tendon involved be slightly on the stretch. t Usually the jerk can be obtained without reenforcement, but it saves time to carryout the entire procedure. In bed-ridden patients the same procedure can be carried outby utilizing o
. Medical diagnosis for the student and practitioner. d jerk of the leg and foot or visible contraction of the musclevaries greatly in health and may be markedly increased in certain conditionsof impaired nutrition associated with nervous instability, hysteria, tetanus, * Tendon Reflexes. (Deep reflexes.) It will be noted that all of the tendon reflexesrequire that the tendon involved be slightly on the stretch. t Usually the jerk can be obtained without reenforcement, but it saves time to carryout the entire procedure. In bed-ridden patients the same procedure can be carried outby utilizing ones own arm and the flexed opposite knee as points of support. SPECIAL REFLEXES H95 strychnin poisoning, rheumatoid arthritis or after sexual excesses and drink-ing bouts, and is pathologically increased in any disease which cuts off thecerebral inhibition fibers. Such are cortical hemiplegias and sclerosis (lateralor amyotrophic) of the lateral columns. For clinical purposes one may assume that it is invariably present in health. Its absence 7T<. employed Fig. 594. 1. Knee-jerk elicitation. Method sometimesby author. 2. Simple method. 3. A common method. 4. Ordinary reenforcement method. 5. Method of obtaining Achilles-jerk. 6. Method of eliciting ankle clonus. 7. Method of obtaining triceps-jerk. 8. Method of obtaining jaw-jerk. Westphals Sign, indicates a lesion interrupting the Lost n . ...,., knee-jerk. reflex arc, viz., a lesion involving thesensory or motor fibers (neuritis), theposterior roots or columns, the anteriorcells or even the motorial end plates. Hence it is lost in locomotor ataxia,anterior poliomyelitis, transverse myelitisof the second and third lumbar segments(seat of reflex), Landrys paralysis, Fried-reichs ataxia and sometimes in chorea,diabetes and severe toxemias such asdiphtheria. Cases of pathologic exaggera-tion may yield a series of jerk, on tap-ping the quadriceps tendon. In suchcases especially ankle clonus should besought.* Patellar clonus is
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