The diagnostic ability of railway surgeons is not inquently taxed to its utmost in determining the real [ill] in cases of alleged organic disease of the spinal [ill] in which paralysis is presented as a symptom. The forms of paralysis complained of are either motor or sensory, or both. Spastic forms, with or without trophic conditions, may be left out of consideration for the present at least, as they present features which make them easy of recognition.
In a case of motor or sensory paralysis, or both comined, the questions which will enter the mind of the examiner are three in number: 1. Is the paralysis due to an organic change in the anterior or motor side of the spinal cord, or both in anterior and posterior sides, or are the lines of communication impaired or destroyed by injury to, or disease of, the afferent or efferent nerve-fibers, or both?
FAIRCHILD DS. DIAGNOSTIC VALUE OF THE DEEP REFLEXES OF THE LOWER EXTREMITIES.. JAMA. 1900;XXXIV(14):833-836. doi:10.1001/jama.1900.24610140001001