Nervous and mental diseases . f exten-sion and flexion at the joint, whichtend to persist as long as gentle ten-sion is maintained by the examinerupon the extensors. On the dorsum of the trunk thereare a series of reflexes which, belowthe scapulae, are not of much diag-nostic value, and which can usually be demonstrated by stroking, pinch-ing, or, preferably, percussing the muscular masses. Anteriorly, with thepatient lying supine and the abdominal wall relaxed, a tap on the costalcartilages on either side of the xiphoid depression causes a dimpling orlateral movement at this point, called the
Nervous and mental diseases . f exten-sion and flexion at the joint, whichtend to persist as long as gentle ten-sion is maintained by the examinerupon the extensors. On the dorsum of the trunk thereare a series of reflexes which, belowthe scapulae, are not of much diag-nostic value, and which can usually be demonstrated by stroking, pinch-ing, or, preferably, percussing the muscular masses. Anteriorly, with thepatient lying supine and the abdominal wall relaxed, a tap on the costalcartilages on either side of the xiphoid depression causes a dimpling orlateral movement at this point, called the epigastric reflex. A similar tapon the costal border in the nipple line, acting through the abdominal obliquemuscle, produces the abdominal reflex, most noticeable at the umbilicus,which is promptly drawn toward the side percussed and in the obliquedirection indicated. Sharply stroking the lateral abdominal surfacewith the nail or handle of the percussion hammer will frequently befound the best mode of eliciting this Fig. 6.—Method of eliciting the knee-jerkand reinforcing it hy Jeudrassiks method. 36 NERVOUS AND MENTAL DISEASES. Ill the lower extremities we find that a series of taps along the originof 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 facia? 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 elicited generally by having the patient cross one knee over the otherwhile sitting. The under limb, 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 or the ulnar border of the hand, upon the patellar ligamentor just above the patella, is followed by a
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