GEN. I. SPEC. III. Muscular debility of the fibres of the extensor muscles, proscribes an extended position in every instance; and, as already Entasia observed, recommends a curved relaxing couch in its Rhachybia. stead, so that the patient may sink into it at his ease, in- distortion of stead of being put upon the stretch. The advice is good so the spine. far as the opinion is correct, and the disease is dependent upon debility of the extensor muscles alone: for here nothing can afford so much ease to the patient as such an indulgence. But it is not to be conceded that the fibrous structure of these muscles form the seat of the disease in every case, and consequently the recommendation will not always apply: for the flexor muscles may be affected, or the debility be seated in the extensor ligaments, or the vertebral cartilages with which they are connected. I have at this moment under my care a lady just of age who, for four years past, has been labouring under a slight affection of lateral distortion, feeling much more of it whenever she suffers fatigue, or is affected in her spirits. A position strictly Illustrated. supine, and somewhat extended, upon a hard mattress or a level floor is the only posture that affords her ease, and takes off the sense of weight on the spine, and oppression on the chest. She has often tried other positions but in vain. To this, therefore, she has uniformly recourse after dinner, and, occasionally, at other times in the day as well. Pure country air has also been of great service, but above all things sea-bathing. She has just returned from an excursion around the Devonshire coast. The first day's journey, though in a reclined position in an open landaulet, with every attention that could afford ease and accommodation, proved so fatiguing, and produced so much pain in the spine, that it was doubtful whether she would be able to proceed. A better night, however, than was expected, capacitated her for another trial, and the fatigue was considerably less: on the third or fourth day she had an opportunity of beginning to bathe; and by a daily perseverance in the same was enabled, soon after reaching Teignmouth, to engage in long walks, climb its loftiest hills, and enjoy the entire scenery: her appetite became almost unbounded, and her flagging spirits were restored to vivacity. GEN. I. SPEC. III. Entasia Rhachybia. distortion of the spine. Muscular Hence ges tation, pure air, sea-babathing, and general tonics to combine with the preceding. Rest interrupted rather than continued: except in extreme cases. It is hence perfectly clear that while that position and that mode of dress are most to be recommended which afford the highest degree of ease and comfort; gestation, pure air, sea-bathing, and every other kind of tonic, whether external or internal, are also of the utmost importance; and that perfect and continued rest, in whatever position it be tried, is far less efficacious than when interrupted by such motion as can be borne, though with some degree of fatigue, and the other tonic auxiliaries just adverted to. In extreme cases, indeed, such exercise as is here adverted to should be postponed till the debilitated and, most probably, irritable organs have lost some part of their disease: yet the motion of friction or manipulation by a skilful and dextrous hand may still be adverted to, and should supply its place. GEN. I. SPEC. IV. THE joints of the limbs are as subject to muscular contractions as the neck: and, in many instances, from like causes: the following are the varieties of affection hereby produced : a Irritata. Spastic stiff-joint. B Atonica. Atonic stiff-joint. y Inusitata. Chronic stiff-joint. From excess of action in the muscles contracted. From direct atony in the yield ing muscles. From long confinement or neg lect of use.. GEN. I. SPEC. IV. articularis. Muscular Besides the ordinary causes of cold, inflammation, and strains, by which the first and second variety are produced, Entasia the former has sometimes followed upon a sudden fright*, upon drying up a cutaneous eruption, or checked per- stiff-joint. spiration +. Freind, also, mentions a case in which it has Causes. been cured by a fright‡; and Baldinger one in which it disappeared on the revival of a suppressed eruption which had given rise to it§. Rheumatism has often produced it, and particularly the second variety, in the joint of the knee and thigh-bone. In a case of the latter kind, it was successfuly attack- Treatment. ed by Richter, with a cautery of a cylinder of cotton. In this and the third variety much benefit is often derived from repeated and long continued friction with a warm hand, and particularly if illined with some stimulant balsam or liniment. In an obstinate contraction of the fingers succeeding to a fractured arm, Dr. Eason relates an instance in which the rigidity suddenly gave way to a pretty smart stroke of electricity after every other mean had failed; and the patient had the use of his fingers from this time. Such exercise, moreover, or exertion of the limb, should be recommended as it may bear without fatigue. The cold-bath, as an antispasmodic, has sometimes been serviceable in the FIRST VARIETY, and more frequently, as a tonic, in the SECOND. often produced from habitual neglect of affected. Most men exhibit proofs of the THIRD VARIETY or Chronic chronic stiff-joint, from a neglect of using many of their stiff-joint muscular powers: for nearly a fourth part of the voluntary muscles, from being seldom called into full and active exertion, acquire a stiffness which does not naturally muscles belong to them, while many that, by exercise, might have been rendered perfectly pliant and obedient to the will have lost all mobility, and are of no avail. Tumblers Explained. and buffoons are well aware of this fact, and it is principally by a cultivation of these neglected muscles that they are able to assume those outrageous postures and gri * Starke, Klin. Instit. p. 32. Vit. Gabriel. Chir. Bibl. Band. x. 219. VOL. IV. Ꮓ + Paulini Cent. 1. 39. § N. Magazin. Band. x1. 78. Edin. Med. Comment. v. p. 84. GEN. I. SPEC. IV. Entasia. articularis. Muscular stiff-joint. Treatment. maces, and exhibit those feats of agility which so often amuse and surprise us. It is a like cultivation that gives that measured grace and firmness as well as erect position in walking, by which the soldier is distinguished from the clown; and that enables the musician to run with rapid execution, and the most delicate touch, over keys or finger-holes that call thousands of muscular fibres into play or into quick combinations of action, which in the untutored are stiff and immoveable, and cannot be forced into an imitation without the utmost awkwardness and fatigue. GEN. I. SPEC. V. Origin of specific name: SPECIES V. ENTASIA SYSTREMMA. Cramp. SUDDEN AND RIGID CONTRACTION AND CONVOLUTION OF ONE OR MORE MUSCLES OF THE BODY: MOSTLY OF THE SYSTREMMA, literally" contortio, convolutio", "globus", is derived from σvorpipw, "contorqueo", συστρέφω, "convolvo in fascem". Stremma, the primary noun, is an established technical term for "strain, twist, wrench"; and the author has hence been induced to add the present term to the medical vocabulary in the sense now offered, for invented to the purpose of superseding and getting rid of crampus which has hitherto been commonly employed, though at the same time commonly reprobated, as a term intolerably barbarous, derived from the German krampf. The proper Latin term is, perhaps, "raptus nervorum"; whence opisthotonia or opisthotonus is denominated by the Latin writers" raptus supinus". But raptus is upon the whole of too general a meaning to be employed on the present supersede the barba rous term crampus. Raptus of the Latins, what. GEN. I. occasion, unless with the inconvenience of another term combined with it. SPEC. V. Entasia Parts case, how especially in the long The parts chiefly attacked with cramp are the calves Systremma. of the legs, the neck, and the stomach. The common Cramp. causes are sudden exposure to cold, drinking cold liquids chiefly during great heat and perspiration, eating cold cucurbi- affected. taceous fruits when the stomach is infirm and incapable Causes. of digesting them, the excitement of transferred gout and overstretching the muscles of the limbs, in which last case it is an excess of reaction produced by the stimulus of too great an extension. Hence many persons are subject In the last to it, and especially those of irritable habits, during the produced, warmth and relaxation of a bed, and particularly towards the morning when the relaxation is greatest, the accumulation of muscular or irritable power most considerable, and the extensor-muscles of the legs are strained to their utmost length to balance the action which the flexormuscles have gained over them during sleep. Cold night- Other air is also a common cause of cramp, and it is a still more frequent attendant upon swimming, in which we have How prothe two causes united of cold and great muscular extension. An uneasy position of the muscles is also in many cases a sufficient cause of irritation; and hence we often meet with very painful cases of cramp in pregnant women down the legs, or about the sides, or the hypogastrium. When the hollow or membranous muscles are affected, they feel as though they were puckered and drawn to a point; the pain is agonizing, and generally produces a violent perspiration: and if the stomach be the affected organ the diaphragm associates in the constriction, and the breathing is short and distressing. If the cramp be seated in the more fleshy muscles, they seem to be writhed and twisted into a hard knot, and a knotty induration is perceivable to the touch accompanied with great soreness, which continues for a long time after the balance of power has been restored. muscles. causes of cramp. duced in swimming. Symptoms hollow or membra when the nous mus cles are affected. When the more fleshy muscles are affected. treatment. In common cases where the calves of the legs are Mode of affected, an excitement of the distressed muscles into their usual train of exertion is found sufficient: and hence |