62 G. H. MONRAD-KROHN. M.-N. Kl. 



The supraorbital nerves (and the frontal nerves) are best palpated when 

 the examiner stands behind the patient, who is sitting. Both hands can 

 then be simultaneously employed in palpating the supraorbital edge and 

 adjacent parts of orbita and the forehead — on both sides. 



I have mentioned these technical points at the risk of appearing 

 pedantic. Experience shows that proper attention to these elementary technic- 

 alities greatly influences the results of the examination. 



While the motor disturbances are eithei" stationary or slowly pro- 

 gressive, the sensor}' disturbances may vary in the same patient from time 

 to time. Cases have been met with, where an extensive sensory loss has 

 gradually diminished in the course of the disease. In one case the sen- 

 sory loss nearly disappeared completely in the upper limbs, while the motor 

 disturbances persisted unaltered. One must therefore be extremely careful 

 in utilizing variations in the sensory findings as an indicator of the effect 

 of treatment. 



Reflexes. 



There is not much to be said on this score. The plantar reflex is 

 commonly abolished, due to the peripheral nerve lesion, which cuts oft" both 

 aff"erent and efferent paths. Where it does exist, it is often difficult to judge 

 whether it is normal or not, owing to the Irequent deformities. Only in 

 two cases have I found an inverted planter response. 



The deep reflexes may be unequal on the two sides. Some of them 

 may also be missing; but (when the Achilles tendon reflex is excepted) 

 this is not common. As a rule they are surprisingly well preserved, even 

 in cases where the superficial anaesthesia has reached the proximal parts 

 of the limbs. 



The comparative integrity' of the deep reflexes will be easier to under- 

 stand when one keeps in mind what has been said in the previous chapter 

 about the integrity of the deep sensation. 



The abdominal and cremasteric reflexes are as a rule not altered 

 either. 



Reflexes of spinal automatism I have never found, nor have I ever 

 been able to elicit the so-called "supino-reflexes". 



As an illustration I append the reflex findings in some of my cases. 

 (The corresponding sensory charts are reproduced as illustrations to the 

 previous chapter. 



In the following, + + signifies a reflex of average briskness, -f a feeble 

 reflex and + + + a very brisk reflex, o or -^ absence of reflex, t an ex- 

 tensor response and 4- ^ flexor response.) 



