Text-book of nervous diseases for physicians and students / by H. Oppenheim.

Date:
1911
Catalogue details

Licence: In copyright

Credit: Text-book of nervous diseases for physicians and students / by H. Oppenheim. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    pressed upwards. It has then to be ascertained how much strength is required to call forth this clonus. Beginners usually make the mistake of fixing the foot so strongly in the position of dorsal flexion that a con- traction (plantar flexion) cannot take place. On the other hand one must not relax the pressure too much, as the tension on the foot must always be maintained, since as soon as the ball of the foot is pressed downwards, the tremor ceases. In severe exaggeration, even active dorsi-fiexion of the foot will occasionally give rise to a clonus. A real foot clonus is sometimes simulated by a falae clonus. In this there appear mei'ely a few tremors at unequal intervals, which are not dependent on the tension upon the Achilles tendon, but give the impression of being voluntary movements. This symptom has been noted specially in hysteria. The graphic method has been employed for more exact registration of the movements by Eshner, and specially by Claude and Rose (R. n., 1906), and Ettore Levi [Oher- sieiner, 1907). I have observed another kind of false ankle clonus in paralysis agitans (loc. cit.). In painful rheumatism of the joints also I have found a foot tremor starting from the dorsal flexors, the Achilles jerk remaining normal. Babinski describes a method by which a kind of ankle clonus may be elicited even in liealthy persons. Exaggeration of muscle tonus is sometimes shown by the fact that percussion of the patellar tendon of one side produces contractions in the extensor muscles of the leg on both sides, and even in other muscles of the thigh. Not infrequently percussion of the tibia elicits a contraction of the quadriceps and of the adductors, or the internal rotators of the thigh. Later on we shall more fully discuss another important sign, which has been studied in recent years, and one which is generally associated with or develops upon the same basis as a spastic condition of the muscles, —the so-called Babinski sign, and also a leg phenomenon which I have myself described. The intensity of the tendon phenomena varies within wide limits, even in normal individuals. We cannot lay very great weight upon an exaggeration of the single contractions, as there are a number of conditions which fall within physiological limits in which the tendon phenomena may be temporarilj' exaggerated. Amongst these is the mental excitement which may arise from anxiety as to the examination, or exhaustion after a long march. Then, further, any pain, especially if it be situated in the legs—sciatica for instance—may give rise to exaggeration of the knee jerk. In periostitis and articular rheumatism, in phthisis, in convales- cence from feverish illnesses, and in exanthemata accompanied by severe itching, a simple accentuation of the tendon phenomena is not at all uncommon. This accentuation, therefore, is not in itself sufficient to characterise the condition of the muscles as spastic. Rigidity of the muscles, revealing itself in the prevention of passive movements, is the most essential factor, exaggeration of the tendon phenomena being merely an almost constant accessory symptom. This almost is a necessarj^ limitation, as the degree of tonus in the muscles may be so high that it is impos- sible to elicit a contraction in a muscle which is already contracted to the maximum. Exaggeration of the tendon phenomena very frequently occurs without any trace of muscular rigidity. We shall find that this is a sign of in- creased excitability in the various neuroses (neurasthenia, hysteria, etc.). Increase of muscle tonus—muscular rigidity—also occurs in the
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