GEN. I. SPEC. I. Entasia Priapismus. Cure diffi complaint. It is singular that this spasm should sometimes continue after death: at least we have accounts of such cases in Marcellus Donatus and other writers. As the disease is a case of both local and general de- Priapism. bility, its cure is in most instances difficult. Antispas-cult modics and tonics, are the only medicines that promise relief, as camphor, opium, bark, warm aromatics, warmbathing, cold-bathing: but the whole are often tried without effect. SPECIES II. ENTASIA LOXIA. Wry-neck. PERMANENT CONTRACTION OF THE FLEXOR MUSCLES ON THE RIGHT OR LEFT SIDE OF THE NECK, DRAWING ob GEN. 1. SPEC. II. Origin of THE term LOXIA is derived from the Greek, λogòs, liquus, tortus"; whence loxarthrus in surgery, an obliquity of a joint of any kind, without spasm or luxation. By the specific Greeks, however, the term was specially applied to the term. joints or muscles of the neck. This disease, in its genuine form, proceeds from an ex- Causes. cess of muscular action, particularly of the mastoid muscle on the contracted side. But we frequently meet with a similar effect from two other causes: one in which there is a disparity in the length of the muscles opposed to each other, and consequently a permanent contraction on the side on which they are shortest; and the other in which, from cold or a strain, there is great debility or atony on the side affected, and, consequently, an incurvation of the neck on the opposite side, not from a morbid excess, but an overbalance of action. GEN. I. SPEC. II. Entasia Loxia. Wry-neck. a E. Loxia dispars. Natural wry-neck : mostly congenital. Occasional causes. This species, therefore, offers us the three following varieties: a Dispars. B Irritata. Spastic wry-neck. 7 Atonica. Atonic wry-neck. From disparity in the length of the muscles opposed to each other. From excess of muscular action on the contracted side. From direct atony of the muscles on the yielding side. The FIRST VARIETY is mostly congenital, though sometimes produced by severe burns or other injuries. And a like effect occasionally issues from a cause that may be noticed in the present place, though not connected with a morbid state of the muscles; a displacement of the muscles from an incurvation in the vertebræ of the neck, by which, though the antagonist muscles be of equal length and power, those on the receding side of the neck are kept on a perpetual stretch, while those on the protruding side are in a state of constant relaxation. The other TWO By E. Loxia VARIETIES are commonly the result of cold, or inflammation, or a strain; often by carrying too heavy loads on the head. M. Boyer gives instances of the disease produced by moral causes: and Wepfer relates the case of a man who had a wry-neck, occasioned by a convulsive action of the muscles on one side of the neck, which appeared whenever he was tormented by chagrin, but ceased as soon as he was restored to a state of mental tranquillity*. irritata. E. Loxia atonica. Spastic wry neck. Atonic wry neck. Mode of treatment. The cure must depend upon the nature of the cause. In colds and strains, warmth, the friction of flannel, and the stimulus of volatile or camphor liniment combined with opium, will be found most serviceable, as tending to diminish pain, and restore action to the weakened organ. In direct spasms the same process will also frequently be found useful, but the application of cold water as a tonic and antispasmodic will often answer better. Where the * Traité de Maladies Chirurgicales, &c. Tom. vii. 8vo. Paris, 1821. GEN. I. SPEC. II. Entasia antagonist muscles are of unequal length, the case lies beyond the reach of medical practice, and, if relieved at all, can only be so by a surgical operation. If the cervical Loxia. vertebræ be incurvated, but the bones sound, the disease Treatment. Wry-neck. may not unfrequently be made to yield to a skilful application of machinery by the hands of an ingenious surgeon. It sometimes happens, however, that the bones in this case are soft and occasionally carious, and the slightest motion of the head is attended with intolerable pain. Setons have here been found serviceable, with an artificial support of the head; but this kind of affection is often connected with a constitutional softness of the bones, of which we shall have to treat in the first order of the sixth class, under the head PAROSTIA flexilis. SPECIES III. ENTASIA RHACHYBIA. Muscular Distortion of the Spine. PERMANENT AND LATERAL CURVATURE OF THE spine, DISTORTION of the spine is produced in various ways; and it is chiefly owing to a want of due attention to this fact, that so much confusion has of late prevailed respecting the real nature of the particular case to be treated, and the particular treatment that ought to be adopted. GEN. I. SPEC. III. Various kinds of spinal dis tortion. Spinal distortion as first describ The disease, under this general name, was first introduced before the public with any considerable degree of notoriety by Mr. Pott, as connected with a palsy of the lower extremities, and as dependent upon a scrofulous diathesis; which at length fixed itself upon some part of ducing ed by Pott; scrofulous and pro caries. GEN. I. SPEC. III. Entasia the vertebral column, softened or rendered carious the bones that became affected; and hereby necessarily proRhachybia. duced crookedness, and a morbid pressure upon the right distortion of line of the spinal marrow. Muscular the spine. Rhachetic source. This is a case that often happens, and a like effect occasionally occurs in a very early period of life, from a rhachetic, instead of a scrofulous diathesis; though from the greater facility with which the principle of life is able to adapt itself to deviations from the ordinary laws of health, at this latter period than afterwards, a paralysis of the lower extremities is less common; and even the mischiefs incidental to a misformation of the chest less fatal. So that while the disease of a hump-back can rarely take place in puberty or later life, without a serious injury to almost every function, we often find it occur in infancy, without making much encroachment on the general health. In all cases of this kind the malady is primarily and idiopathically an affection of the vertebral bones; and primary af- there is always to the touch a mollescence in their structure, or a manifest soreness and ulceration. And from the peculiar contour of the vertebral column the distortion is always from within outwards, forming what has been called an angular, in contradistinction to a lateral curvature. So that the characters of the osseous gibbosity are sufficiently clear and specific. In these cases the disease a fection of the bones. Producing angular dis tortion, as opposed to lateral. Muscular or cartil aginous contortion. But the muscles of the vertebral column, and their apligamentous pendages, the ligaments and cartilages into which the latter are inserted, are of as much importance to its healthy contour as its bones. And hence any morbid affection in any of these moving powers may as essentially interfere with the natural curve of the spine, and the well-being of the constitution, as a disease of the vertebral bones. These organs sometimes affected singly, sometimes jointly. But most frequently the muscles. It is possible that these are all affected in particular instances, sometimes separately, sometimes jointly *; but there can be no doubt that the muscular fibres of the neck, back, and loins, those on which all the complicated movements of the vertebral column depend, and which • Copeland's Observations on the Spine, p. 15.. GEN. I. SPEC. III. Entasia Muscular distortion of In these cases the distortion [ORD. III. give rise to more than three hundred distinct muscles in the whole, are most frequently thus enfeebled either in part or in their entire range; though an enfeebled state Rhachybia. of any of these organs must produce an inability of preserving the spine in its natural sweep and equilibrium. the spine. And where distortion proceeds from this cause the indications are in most cases as clear as where it is the result of a diseased condition of the bony structure: for first the morbid curvature instead of being from within outwards, takes place laterally, the crookedness being manifestly on the right or the left side according as the muscles on the one side or the other overpower the action of their antagonists; there is little or no soreness upon pressure, unless indeed the bones or their cartilages should ultimately become affected from the protracted state of the disease; and, the distortion being less abrupt or angular than in the ossific gibbosity, the lower limbs are not affected with paralysis. lateral alone. Lordosis, what. The distinction therefore between the osseous and the Distinction observed by muscular distortion of the spine is clear and definite; and the Greek so far as regards the peculiar character of the curvature writers. was minutely noticed by the Greek writers, who identified the first by the names of LORDOSIS OF CYRTOSIS, ac- what. cording as this curvature was anterior or posterior, and Cyrtosis, the second or the lateral curvature by the term HYBOSIS, Hybosis, from 6òs (hybus) incurvus. It is from this term that what. the author has derived the name which he has ventured to assign to the present species-RHACHYBIA—as an allowable, contraction of rhachyhybia, literally SPINAL INFLEXION. Swediaur has denominated it from the same source, hyboma Scoliosis *. The distinction is very accurately pointed out by Mr. Pott, who, while he affirms that "the ligaments and cartilages of the spine may become the seat of the disorder (scrofula) without any affection of the vertebræ"; in which case "it sometimes happens that the whole spine, from the lowest vertebra of the neck downwards, gives way * Tom. I. p. 740. Well dis criminated by Pott. |