602 



LEWELLYS F. BARKER 



nated as "a hitherto unknown symptom in tetany (leg phenomenon)." 

 He was at that time unaware of Pool's earlier observations, but in a 

 later paper, published in the same year, he recognized Pool's priority of 

 observation and report. Sehlesinger made an exhaustive study of the 

 leg phenomenon ("Beinphanomen"), and both of his papers should be 

 carefully read by students of tetany. 



To perform the test for the leg 

 phenomenon, Sehlesinger grasps 

 the legs, with the knees strongly 

 extended, below the calves, and 

 flexes the thighs markedly at the 

 hip joints. When the test is posi- 

 tive, spasm of the extensors of the 

 knee and extreme supination of 

 the foot set in after a short time, 

 within two minutes at the latest 

 (Fig. 7). Flexion of the toes was 

 not observed in the first case 

 studied. Sehlesinger believed that 

 this leg phenomenon depends upon 

 strong flexion at the hip joint and 

 that it will appear in both legs if 

 the patient sit up in bed with the 

 knees extended. Furthermore, if 

 the standing patient flex the body 

 on the hips, with the knees ex- 

 tended, the phenomenon also ap- 

 pears after about the same length 

 of time has elapsed. Paresthesias 

 regularly precede the development 

 of the tonic contractures in the ex- 

 tremities examined. On the other 

 hand, the phenomenon cannot be 



Fio. 7. The L(\u Phenomenon (Bdn- elicited merely by pressing upon 

 ph(inomen). (After H. Sehlesinger, Wien. ,, . ,. , . f . - 



klin. Wclmschr., 1910.) the sciatic nerve or by pinching 01 



the skin. Sehlesinger decided 



that the sign cannot depend entirely upon stimulation of the sciatic nerve, 

 since muscles that are not innervated by the ischiadicus (e.g., the extensor 

 muscles of the knee joints) participate in the spasm. Undoubtedly the 

 sciatic nerve is mechanically irritated on applying the test, but the motor 

 nerves concerned must, Sehlesinger thinks, be excited reflexly. The phe-' 

 iioinenoii would therefore seem to be due partly to direct, partly to reflex, 

 stimulation of hyperexcitable nerves. The starting point of the stimulus 

 is the stretching of the nervus ischiadicus, and this stimulation is followed 



