A note on excessive patellar reflex of functional nervous origin, and especially the 'trepidation' or 'spinal epilepsy' form / by F. Parkes Weber.

  • Weber, Frederick Parkes, 1863-1962.
Date:
1908
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Licence: In copyright

Credit: A note on excessive patellar reflex of functional nervous origin, and especially the 'trepidation' or 'spinal epilepsy' form / by F. Parkes Weber. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    functional NERVOUS ORIGIN, AND ESPECIALLY THE “ TREPIDATION” OR “SPINAL EPILEPSY” FORM. Bt F. PARKES WEBER, M.D., F.R.O.P., PHYSICIAN TO THE GEHMAN HOSPITAL, LONDON, AND THE MODNT VEENON HOSPITAL FOB CHEST DISEASES, HAMPSTEAD. 1 THINK that too much value la sometimes attributed to the phenomenon of excessive knee-jerks as suggestive of the presence of organic nervous disease. It has been stated that in patients who have had syphilis the presence of excessive knee-jerks should lead one to suspect the commencement of syphilitic disease of the central nervous system; but in examinations for life assurance and In ordinary medical examinations one so frequently finds excessive knee-jerks* apart from any nervous disease whatever that I now regard the mere presence of excessive knee-jerks apart from other symptoms as practically without any pathological significance. I quite admit, however, that this “ functional ” excess of patellar refiex is especially likely to be found in individuals with a neurasthenic tendency and In persons of a rather weak habit of body who are easily thrown Into a state of nervous excitement, and that it Is more frequently found In persons of Jewish than of Northern European descent. The class of so-called “hysterical malingerers” will doubtless also be found often to show excess of patellar refiex. Extreme exaggeration of patellar reflex, especially what I would term the “ trepidation ” or “ spinal epilepsy ” formt (when in addition lo a violent knee-jerk there is •Incidentally I would remark that examination of knee-jerks in ordinary routine cases teaches one also not to rely too much on the absence of knee-jerks as a sign of there being organic nervous disease (especially tabes dorsalis) present. Whatever may be said to the con- trary, there are a certain number of healthy persons in whom knee- jerks cannot be obtained even by the help of devices such as making the person who is being examined lock his hands together and puU apart. Of course, it can always be objected that the absence of knee- jerks is only temporary in such cases ; but it must bo admitted that there are apparently healthy persons in whom the knee-jerks are either persistently (congenitally ?) or temporarily absent. t In some of these cases a gentle tap on the bone (that is, peri- osteum) anywhere near the patellar tendon is sufficient to produce a violent knee-jerk with “ trepidation.” [650/07]