The diagnosis of diseases of the spinal cord.

  • Gowers, W. R. (William Richard), 1845-1915.
Date:
1880
Catalogue details

Licence: Public Domain Mark

Credit: The diagnosis of diseases of the spinal cord. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    32/126 (page 20)
    for generations amused schoolboys, should have become an important clinical symptom. To obtain the jerk, the knee must be flexed so that the quadriceps femoris is gently extended, and the leg must be free to move. If then the patellar tendon is struck, the quadriceps contracts and jerks the leg forwards. The most convenient position is with the knee to be tested flexed nearly, but not quite, at a right angle. The posture commonly employed is with the leg to be tested across the other, the knee of the supporting leg being at a right angle (Fig. 7). But if the leg to be tested is stout, its tension in this position may be too great to permit of any movement. In such case the best posture is for the observer to place his arm beneath the patient's thigh, just above the knee, and rest his hand on the patient's other knee (Fig. 8). Not long ago I saw a rather stout man, well known to many members of our profession, who was uneasy because a physiological friend had been unable to produce this phenomenon upon him. His legs were so stout that, in the posture commonly employed, no movement occurred when the patellar tendon was struck. But when the thigh rested on the observer's arm, in the way I have described, the tap on the tendon caused a ready jerk, much to the satisfaction of the individual examined, whose anticipations of impending locomotor ataxy were thus removed. Children may sit on tho edge of a chaii-, adults on the edge of a table; but if so, and the legs are vertical, the effect of the blow and of the muscular contraction must be carefully distinguished. The side of the extended hand is a convenient instrument for giving the blow (Fig. 7). Now and then, when very slight, a percussion hammer (Fig. 8), or a stethoscope with an india-rubber edge to the ear-piece,* elicits it more readily, especially when (as in children) the space between the patella and tibia is too small to permit of a suitable blow ■^^•ith the hand. It may commonly be obtained as readily through one or two garments as upon the skin. If its existence • Such stethoscopes -were fonnerly in use for percussion of the chest, and can be obtained of most instrument makers.