Zoonomia; Or, the Laws of Organic Life, Vol. II

by Erasmus Darwin

Your correspondent teeth will clatter.

Prior.

In more acute pains the jaws are gnashed together with great vehemence, insomuch that sometimes the teeth are said to have been broken by the force. See Sect. XXXIV. 1. 3. In these cases something should be offered to the patient to bite, as a towel, otherwise they are liable to tear their own arms, or to bite their attendants, as I have witnessed in the painful epilepsy.

[13]. Tetanus trismus. Cramp. The tetanus consists of a fixed spasm of almost all the muscles of the body; but the trismus, or locked jaw, is the most frequent disease of this kind. It is generally believed to arise from sympathy with an injured tendon. In one case where it occurred in consequence of a broken ankle from a fall from a horse, it was preceded by evident hydrophobia. Amputation was advised, but not submitted to; two wounds were laid into one with scissors, but the patient died about the seventh day from the accident. In this case the wounded tendon, like the wounds from the bite of a mad dog, did not produce the hydrophobia, and then the locked jaw, till several days after the accident.

I twice witnessed the locked jaw from a pain beneath the sternum, about the part where it is complained of in painful asthma, or angina pectoris, in the same lady at some years distance of time. The last time it had continued two days, and she wrote her mind, or expressed herself by signs. On observing a broken tooth, which made a small aperture into her mouth, I rolled up five grains of opium like a worm about an inch long, and introducing it over the broken tooth, pushed it onward by means of a small crow-quill; as it dissolved I observed she swallowed her saliva, and in less than half an hour, she opened her mouth and conversed as usual.

Men are taught to be ashamed of screaming from pain in their early years; hence they are prone to exert the muscles of the jaws instead, which they have learnt to exert frequently and violently from their infancy; whence the locked jaw. This and the following spasm have no alternate relaxations, like the preceding ones; which is perhaps owing, first, to the weakness of their antagonist muscles, those which elevate the jaw being very strong for the purpose of biting and masticating hard substances, and for supporting the under jaw, with very weak antagonist muscles; and secondly, to their not giving sufficient relief even for a moment to the pain, or its preceding irritation, which excited them.

M. M. Opium in very large quantities. Mercurial ointment used extensively. Electricity. Cold bath. Dilate the wound, and fill it with lint moistened with spirit of turpentine; which inflames the wound, and cures or prevents the convulsions. See a case, Transact. of American Society, Vol. II. p. 227.

Wine in large quantities in one case was more successful than opium; it probably inflames more, which in this disease is desirable. Between two or three ounces of bark, and from a quart to three pints of wine a day, succeeded better than opium. Ib.

[14]. Tetanus dolorificus. Painful cramp. This kind of spasm most frequently attacks the calf of the leg, or muscles of the toes; it often precedes paroxysms of gout, and appears towards the end of violent diarrhœa, and from indigestion, or from acid diet. In these cases it seems to sympathize with the bowels, but is also frequently produced by the pain of external cold, and to the too great previous extension of the muscles, whence some people get the cramp in the extensor muscles of the toes after walking down hill, and of those of the calf of the leg after walking up a steep eminence. For the reason why these cramps commence in sleep, see Sect. XVIII. 15.

The muscle in this disease contracts itself to relieve some smaller pain, either from irritation or association, and then falls into great pain itself, from the too great action of its own fibres. Hence any muscle, by being too vehemently exerted, falls into cramp, as in swimming too forcibly in water, which is painfully cold; and a secondary pain is then induced by the too violent contraction of the muscle; though the pain, which was the cause of the contraction, ceases. Which accounts for the continuance of the contraction, and distinguishes this disease from other convulsions, which are relaxed and exerted alternately. Hence whatever may be the cause of the primary pain, which occasions the cramp of the calf of the leg, the secondary one is relievable by standing up, and thus by the weight of the body on the toes forcibly extending the contracted muscles. For the cause, which induces these muscles of the calf of the leg to fall into more violent contraction than other spasmodic muscles, proceeds from the weakness of their antagonist muscles; as they are generally extended again after action by the weight of the body on the balls of the toes. See the preceding article.