GEN. I. SPEC. V. Entasia most people cure themselves by suddenly rising into an erect position. I have often produced the same effect Systremma. and overcome the re-action without rising, by forcibly Cramp. stretching out the affected leg by means of other muscles, whose united power overmatches that of the muscle that is contracted. Warm friction with the naked hand, or, which is better, with the hand illined with camphorated oil or alcohol, will also generally be found to succeed. A forcible exertion of some remote muscles, which thus collects and concentrates the irritable power in another Vulgar plan quarter, will also frequently effect a cure; and it is to this principle alone, I suppose, we are to refer the benefit which is said to arise from squeezing strenuously a roll of brimstone, which suddenly snaps beneath the hold. The brimstone snaps from the warmth of the hand applied to it; but its only remedial power consists in affording a something for the hand to grasp vehemently, and thus excite a sudden change of action. of squeez ing a roll of brim stone ex plained. Treatment where the stomach is affected. Treatment Where the stomach is affected, brandy, usquebaugh, ether, or laudanum afford the speediest means of cure; and it is often necessary to combine the laudanum with one or the other of the preceding stimulants. Here also the external application of warmth, and diffusible irritants, as hot flannels moistened with the compound camphor liniment, are found in most cases peculiarly beneficial. Exciting a transfer of action to the extremities, as by bathing the feet in hot water, or applying mustard sinapisms to them, is frequently of great advantage; as is the use of hot, emollient and anodyne injections, whose palliative power reaches the seat of spasm by sympathetic diffusion, and often affords considerable quiet. Here, also, the patient should be particularly attentive to his diet and regimen, confining himself to such viands as are most easy of digestion, and least disposed to rouse the stomach to a return of these morbid and anomalous actions; for a habit of recurrence is soon established, which it is difficult to break off. In pregnancy, where the crampy spasms are often under preg migratory and fugitive, the position should frequently nancy. GEN. I. SPEC. V. be changed, so as to remove the stimulus of uneasiness by throwing the pressure upon some other set of muscles: Entasia and if the stomach be affected with gout, opium, rhubarb, Systremma. Cramp. chalk, or aromatics should be taken on going to rest. Best pre The best preventives when the cause is constitutional, ventives. are warm tonics, and habituating the affected muscles to as much exercise as their strength will bear: and hence the same forcible extension used in swimming which produces cramp the first or second time of trial, will rarely do so afterwards. Cramp is also found, as a symptom, and as one of the severest symptoms of the discase, in various species of colic and cholera; in which cases it must be treated according to the methods already pointed out under those respective heads. Found also as a sym ptom in many dis eases. SPECIES VI. ENTASIA TRISMUS. Locked-Jaw. PERMANENT AND RIGID FIXATION OF THE MUSCLES OF THE LOWER JAW. The GEN. I. SPEC. VI. ❝ to French sy THIS disease is by the French writers called tic. technical term is derived from the Greek piw, gnash or grind the teeth"; which, like the French sy- nonym. nonym, is supposed by the lexicographers to be an onomatopy, or a word formed from the sound that takes place in the act of gnashing. Origin of cal term the techni Greek and formerly In truth it was to a disease in which morbid gnashing Both the formed a symptom, that both the Greek and French French term was originally applied; for the trismus of the old terms writers consisted, not of a rigid, but a convulsive or applied to a agitatory spasm of the lower jaw; an affection compara- different aftively trifling, and rarely to be met with, and when it does occur appertaining to the CLONUS of the present system of nosology, the clonic spasm of authors in ge fection: GEN. I. Entasia and recently Akerman. neral. And the use of trismus or tic to import a state of muscle directly opposed to that which it first indicated, is another striking proof of the incongruous change which is perpetually occurring in the nomenclature of medicine, for the want of established rules and principles to give fixation and a definite sense to its respective terms. Dr. Akerman is the only writer of reputation I am so applied by acquainted with in recent times, who has used trismus in its original intention; or rather who has united its original with its modern meaning. For he employs the term generically; and arranges under it the two species of trismus tonicus, being that now under consideration, and trismus clonicus, or the disease it originally denoted. But this arrangement is uncalled for, and inconvenient, and has not been received into general use: the term trismus being, with every writer of the present day, limited to the first of these two species alone, notwithstanding the origin of the word. And hence, as it is so generally and completely understood, there would be an affectation in changing it for any other. The Germans call it kinnbakkenzwange, which is precisely parallel with the LOCKED-JAW of our own tongue. German synonym. Variously and irregularly arranged by Cullen: at one time a distinct trismus which was also made a distinct Dr. Cullen in the first edition of his Nosology, made trismus and tetanus, our next species, distinct genera, but he altered his opinion before the publication of his First Lines, and regarded them as nothing more than degrees or varieties even of the same species. "From genus from the history of the disease," says he, "it will be evident that there is no room for distinguishing the tetanus, opisthotonos, and trismus or locked-jaw as different species of this disease; since they all arise from the same causes, and are almost constantly conjoined in the same perreduced to a son. In consequence of which, in the later editions of variety of a Dr. Cullen's Synopsis, in which the supposed error is attempted to be corrected, the disease is introduced with a very singular departure from nosological method: for first, tetanus is employed as the term for a distinct genus, genus: at other times both common genus. * Pract. of Phys. Book. III. Sect. L. Chap. I. § MCCLXVII. defined "a spastic rigidity of many muscles"; and next GEN. I. SPEC. VI. under this generic division are given no species whatever Entasia but two varieties of degree alone, to the first of which is Trismus. again applied the name of TETANUS, defined "the half Locked-jaw. or whole of the body affected with spasms "; and to the second that of TRISMUS ; defined" spastic rigidity chiefly of the lower jaw." place in a middle line of arrange forming a Passing by this irregularity of method, the proper Proper view of the subject seems to lie in a middle course; in contemplating trismus and tetanus, not as distinct genera, or mere varieties of a single disease, but as distinctment, each species of a common genus; and under this view it is distinct contemplated in the present arrangement. Trismus bears species. Analogy. the same relation to tetanus as synochus does to typhus ; the two former, like the two latter, may proceed from a common cause and require a similar treatment; and the first may terminate in the last. But trismus, like synochus, may run its course alone, and continue limited to its specific symptoms. And as Dr. Cullen has thought proper to make synochus and typhus distinct genera, he ought at least to have ranked trismus and tetanus as distinct species. Found ge nerally in ments, and Trismus is found in all ages, sexes, temperaments, and climates. In warm climates, however, it occurs far more all ages, frequently than in cold; and chiefly in the hottest of temperawarm climates. Dr. Cullen observes that the middle- climates. aged are most susceptible of the disease, men more so than women, and the robust and vigorous than the weakly. Other animals are subject to this complaint as well as man, particularly parrots; and from many of the In other animals as well as in man. These causes, for the most part, are chilliness and damp Causes. operating upon the body when heated, and hence sudden vicissitudes of heat and cold; wounds, punctures, lacerations, or other irritations of nerves in any part of the body, whence it has not unfrequently followed on venesection when unskilfully performed†, and still more fre Bajon. Abhandlungen Von Krankheit auf der Insel Cayenne, &c. + Delaroche, Journ. de Med. Tom. xv. p. 213. Forestus. Lib. x. Obs. 111. Schenck, Obs. L. 1. N. 250. SPEC. VI. Entasia Trismus. GEN. I. quently on amputation, worms or other acrimony in the stomach, and especially in those of infants. We have thus the three following varieties offered to us, which, Locked-jaw. however, chiefly differ in symptoms peculiar to the period of life in which the disease is most disposed to show itself, or in the interval between the casual excitement and the spastic action: Pathological principle diffi cult: but attempted to be explain ed by the author in part, especially the principle of re mote action between the a Nascentium. Locked-jaw of infancy. B Algidus. Catarrhal locked-jaw. 7 Traumaticus. Attacking infants during the first fortnight after birth. Occurring at all ages, after exposure to cold and damp, especially the dew of the evening, the symptoms usually appearing within two or three days. Occurring as the consequence of a wound, puncture, or ulcer; chiefly in hot climates; and rarely appearing till ten days or a fortnight after local affection. The pathology is highly difficult, if not mysterious, and has hence been purposely avoided by most preceding writers. Dr. Cullen expressly avows that he " cannot in any measure attempt it." There is one principle, however, to which I have frequently had occasion to direct the reader's attention, which will help us in a considerable degree to develope something of its obscurity, and to account more especially for so remote a separation between the seat of primary irritation and that of spasmodic excitement, which constitutes, perhaps, its most embarrassing feature. The principle I allude to is the sympathy that prevails throughout the whole of any chain of organs, whether continuous or distinct, engaged in a common function, and which is particularly manifest at its extremities; so that let a morbid action commence in whatever part of the chain it may, the extremities, in * Pract. of Phys. Book 1. Sect. 1. Chap. 1. § MCCLXIX. |