patient does not gesticulate but remains
immovable like a statue with his eyes cast down. Degenerates manifest a
fairly varied series of involuntary motions,--twitchings of the muscles,
as in chorea, tonic and clonic convulsions and tremors. In senility,
chorea, and Parkinson's disease, the tremors are incessant and continue
even when the body is in a state of repose; in sclerosis, goitre, and
chronic inebriety they accompany voluntary movements, and in this case
they are easily detected by making the patient lift the tip of his
finger to his nose or a filled glass to his lips. The nearer the hand
approaches its goal, the more intense the oscillations become. Above
all, the examiner should not fail to ask the patient to put out his
tongue. If it protrudes on one side, it is a sign of a serious nervous
alteration and nearly always denotes the beginning or remains of
paralysis, or partial apoplectic strokes.

_Muscular Strength_ is measured by a common dynamometer (Fig. 38), which
the patient is requested to grasp with all his might. Compressive
strength is tested by compressing the oval. In order to test tractive
strength, the dynamometer is fastened to a nail at the point C, and the
patient pulls with all his strength at D. The effort is registered on a
graduated scale and is of importance for detecting left-handedness and
measuring the extraordinary force that is displayed in certain states of
excitement.

=Fig. 38
Dynamometer=

_Reflex Action_ consists of movements and contractions produced by an
impression exciting the nerves of the cutis (cutaneous reflex) or
tendons (tendinous reflex).

_Cutaneous Reflex Movements_ may be tested by placing the patient in a
recumbent position and stroking methodically certain parts of the body,
the sole of the foot (plantar reflex), the under side of the knee-joint
(popliteal reflex), the abdominal wall (abdominal reflex). Certain
reflex movements are of special importance: the cremasteric reflex, on
the inner side of the thigh (obtuse in old people and individuals
addicted to onanism), the reflex action of the mucous membrane covering
the cornea (suspended during stupor, coma, and epileptic convulsions),
and the pharyngeal reflex along the isthmus of the fauces (absent in
hysterical persons).

The dilatation and contraction of the pupil in accommodation to the
distance of the object viewed or in response to light stimuli is
undoubtedly the most important cutaneous r