Abstract
In the late 1800s, Wilhelm Erb, Joseph Babinski, William Gowers, and others helped develop the neurologic examination as we know it today. Erb was one of the first to emphasize a detailed and systematic neurologic exam and was co-discoverer of the muscle stretch reflex, Gowers began studying the knee jerk shortly after it was described, and Babinski focused on finding reliable signs that could differentiate organic from hysterical paralysis. These physicians and others emphasized the bedside examination of reflexes, which have been an important part of the neurologic examination ever since. This review will focus on the history of the examination of the following muscle stretch and superficial/cutaneous reflexes: knee jerk, jaw jerk, deep abdominal reflexes, superficial abdominal reflexes, plantar reflex/Babinski sign, and palmomental reflex. The history of reflex grading will also be discussed.
Similar content being viewed by others
References
Anonymous (1919) Vanderbilt Clinic Department of Neurology Exam Blank. Hoeber PB, New York City
Babinski J (1903) De l’abduction des orteils. Revue Neurologique 11:728–729
Babinski J (1900) Diagnostic différentiel de l’hémiplégie organique et de l’hémiplégie hystérique. Gazette des Hôpitaux 73(521–527):533–538
Babinski J (1897) Discussion, Congrès international de Neurologie de Bruxelles. Bulletin Médicale 11:896
Babinski J (1898) Du phénomène des orteils et de sa valeur sémiologique. Semaine Médicale 18:321–322
Babinski J (1896) Relachement des muscles dans l’hémiplégie organique. Comptes Rendus des Séances et Mémoires de la Société de Biologie 48:471–472
Babinski J (1896) Sur le réflexe cutané plantaire dans certains affections organiques du système nerveux central. Comptes Rendus des Séances et Mémoires de la Société de Biologie 48:207–208
Beevor CE (1886) A case of amyotrophic lateral sclerosis with clonus of the lower jaw. Brain 8:516–518
Bickerstaff ER (1963) Neurological examination in clinical practice. Blackwell Scientific Publications, Oxford
Bowditch HPaW, J W (1890) The knee-jerk and its physiological modifications. J Physiol 11:25–64
Bradley WG (1994) Myotatic reflex scale. Neurology 44:1984
Bramwell B (1882) The diseases of the spinal cord. Maclachlan and Stewart, Edinburgh
Buzzard T (1878) Some points in the diagnosis of spinal sclerosis. Lancet 112:111–112
Byrnes CM (1929) The abdominal reflexes. South Med J 22:260–267
Charcot JM, Goetz CG (1987) Charcot, the clinician: the Tuesday lessons: excerpts from nine case presentations on general neurology delivered at the Salpêtrière Hospital in 1887-88. Raven Press, New York
Clarke E, O’Malley CD (1968) The human brain and spinal cord; a historical study illustrated by writings from antiquity to the twentieth century [by] Edwin Clarke and C. D. O’Malley. University of California Press, Berkeley
Collier J (1899) An investigation upon the plantar reflex, with reference to the significance of its variations under pathological conditions, including an enquiry into the aetiology of acquired pes cavus. Brain 22:71–99
Critchley M (1949) Sir William Gowers, 1845–1915: a biographical appreciation. William Heinemann Medical Books, London
de Watteville A (1886) A note on the jaw-jerk, or masseteric tendon reaction, in health and disease. Brain 8:518–519
Denny-Brown D (1946) Handbook of neurological examination and case recording. Harvard University Press, Cambridge
Dick JP (2003) The deep tendon and the abdominal reflexes. J Neurol Neurosurg Psychiatry 74:150–153
Dyck PJ, Boes CJ, Mulder D, Millikan C, Windebank AJ, Espinosa R (2005) History of standard scoring, notation, and summation of neuromuscular signs. A current survey and recommendation. J Peripher Nerv Syst 10:158–173
Erb W (1875) Ueber Sehnenreflexe bei Gesunden und bei Rückenmarkskranken. Archiv für Psychiatrie und Nervenkrankheiten 5:792–802
Fine EJ, Lohr LA (2003) The chin reflex. Muscle Nerve 27:386
Fine EJ, Ziad Darkhabani M (2010) Chapter 16: history of the development of the neurological examination. Handb Clin Neurol 95:213–233
Finger S (2000) Minds behind the brain: a history of the pioneers and their discoveries. Oxford University Press, Oxford
McHenry LC (1969) Garrison’s history of neurology: rev. and enl. with a bibliography of classical, original and standard works in neurology. Thomas, Springfield
Gerhardt D (1895) Über das Verhalten der Reflexe bei Querdurchtrennung des Rückenmarkes Deutsche Zeitschrift für. Nervenheilkunde 6:127–136
Gilman S (1982) D. Denny-Brown, 1901–1981. Neurology 32:1–6
Goetz CG (2002) History of the extensor plantar response: Babinski and Chaddock signs. Semin Neurol 22:391–398
Goetz CG, Bonduelle M, Gelfand T (1995) Charcot: constructing neurology. Oxford University Press, New York
Gowers WR (1895) Clinical lectures on diseases of the nervous system; delivered at the National hospital for the paralysed and epileptic. P. Blakiston, son & co., Philadelphia, London
Gowers WR (1884) The diagnosis of diseases of the spinal cord. Churchill, London
Gowers WR (1880) The diagnosis of diseases of the spinal cord. Churchill, London
Gowers WR (1881) The diagnosis of diseases of the spinal cord. Churchill, London
Gowers WR (1885) Diagnostic value of the so-called “tendon-reflexes”. Lancet 126:839–842
Gowers WR (1886) A manual of diseases of the nervous system. Churchill, London
Gowers WR (1903) The rate of nerve impulses. Nature 69:105
Gowers WR (1879) A study of the so-called tendon-reflex phenomena. Medico-Chirurgical Trans 62:269–305
Gowers WR (1903) William Gowers to Moses Starr. Obit File. Yale University Historical Library, New Haven
Grainger Stewart T (1878) Tendon-reflex: a clinical lecture. Med Times Gaz I:107–108
Grinker RR (1934) Neurology. Thomas, Springfield
Hallett M (1993) NINDS myotatic reflex scale. Neurology 43:2723
Ionita C, Fine EJ (2003) A Romanian neurologist and neurophysiologist. J Hist Neurosci 12(206):202–221
Jendrassik E (1885) Zur Untersuchungsmethode des Kniephänomens. Neurol Centralbl 4:412–415
Koehler PJ, Bruyn GW, Pearce J (2000) Neurological eponyms. Oxford University Press, New York
Lehoczky T, Fodors T (1953) Clinical significance of the dissociation of abdominal reflexes. Neurology 3:453–459
Lewis MJ (1885) The chin reflex. A new clinical observation. Med Surg Report 52:591
Louis ED (2008) Weir Mitchell’s 1859 demonstration of “a peculiar contraction” produced by a percussion hammer. Neurology 70:969–973
Marie P (1895) Lectures on diseases of the spinal cord. The New Sydenham Society, London
Marinesco G, Radovici A (1920) Sur un réflexe cutané nouveau a réflexe palmo-mentonnier Revue Neurologique 27:237–270
Members of the Sections of Neurology and Section of Physiology, Mayo Clinic (1956) Clinical examinations in neurology. Saunders, Philadelphia
Monrad-Krohn GH (1923) The clinical examination of the nervous system. 2nd edn. H. K. Lewis, London
Monrad-Krohn GH (1926) The clinical examination of the nervous system. 3rd edn. H. K. Lewis, London
Monrad-Krohn GH (1921) The clinical examination of the nervous system. H. K. Lewis, London
Monrad-Krohn GH (1925) Technique clinique d’examen complet du systeme nerveux. Librairie E. le Francois, Paris
Owen G, Mulley GP (2002) The palmomental reflex: a useful clinical sign? J Neurol Neurosurg Psychiatry 73:113–115
Philippon J, Poirier J (2009) Joseph Babinski: a biography. Oxford University Press, Oxford, New York
Pryse-Phillips W (2003) Companion to clinical neurology. Oxford University Press, Oxford, New York
Purdon Martin J (1982) Personal account of a career in neurology. BMJ 284:1624
Rosenbach O (1876) Ein Beitrag zur Symptomatologie cerebraler Hemiplegieen. Archiv für Psychiatrie und Nervenkrankheiten 6:845–851
Schiller F (1967) The reflex hammer. In memoriam Robert Wartenberg (1887–1956). Med Hist 11:75–85
Strümpell A (1896) Zur Pathologie der multiplen Sclerose. Neurol Centralbl 15:961–964
van Gehuchten A (1898) Le phénomène des orteils. Journal de Neurologie 3:153–155
van Gijn J (1996) The Babinski sign: a centenary. Universiteit Utrecht, Utrecht
van Gijn J (1996) The Babinski sign: the first hundred years. J Neurol 243:675–683
van Gijn J (1977) The plantar reflex. A historical, clinical and electromyographic study. Thesis, University of Rotterdam
van Gijn J (2010) Réflexes de défense. By J. Babinski, Brain 1922: 45; 149–184; with The physiological significance of the reflex phenomena in spastic paralysis of the lower limbs. By F. M. R. Walshe, Brain 1914: 37; 269–336; and The Babinski plantar response, its forms, and its physiological and pathological significance. By F. M. R. Walshe, Brain 1956: 79; 529–556. Brain J Neurol 133:1292–1294
Waller AD (1903) The velocity of a nervous impulse. Nature 69:151
Wartenberg R (1953) Diagnostic tests in neurology: a selection for office use. Year Book Publishers, Chicago
Wartenberg R (1945) The examination of reflexes, a simplification. The Year book publishers, Chicago
Wartenberg R (1937) A pinwheel for neurologic examination. JAMA 109:1294
Wechsler IS (1927) A text-book of clinical neurology. W. B Saunders, Philadelphia
Weir Mitchell S (1882) Clinical remarks on facial neuralgia, treated by neurectomy. Med News 40:257–259
Weir Mitchell S (1888) On the muscular reactions known as tendon-jerks and muscle-jerks. Med News 52:677–685
Weir Mitchell S, Lewis MJ (1886) Physiological studies of the knee-jerk, and of the reactions of muscles under mechanical and other excitants. Med News 48(169–173):198–203
Weir Mitchell S, Lewis MJ (1886) The tendon-jerk and muscle-jerk in disease, and especially in posterior sclerosis. Am J Med Sci 92:363–372
Westphal C (1875) Ueber einige Bewegungs-Erscheinungen an gelähmten Gliedern. Archiv für Psychiatrie und Nervenkrankheiten 5:803–834
Acknowledgments
This research received no specific grant from any funding agency in the public, commercial, or not-for profit sectors.
Conflicts of interest
Dr. Boes serves as a Book Review Editor for Neurology® and as a Contributing Editor to Headache Currents.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Boes, C.J. The history of examination of reflexes. J Neurol 261, 2264–2274 (2014). https://doi.org/10.1007/s00415-014-7326-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00415-014-7326-7