TREATMENT OF SPASM 73 



toxin, and ammonia, by rabies and other animal toxins, as 

 well as by the altered condition of the blood in asphyxia, and 

 by sudden anaemia of the medulla from copious blood-letting. 

 This spasm centre appears to be in an abnormal state in 

 epilepsy, when its inordinate action is directly controlled by 

 bromides. The tonic spasms of tetanus, and strychnine- 

 poisoning, are relieved by bromides, chloral hydrate, and 

 nicotine. 



But spasms are more frequently local than general. They 

 have been defined as a kind of insubordination, in which 

 the individual muscles or nerve-centres act for themselves, 

 without reference to those higher centres which ought to 

 co-ordinate their action for the general good of the organism. 

 Spasm may be due, therefore, to an excess of action in the 

 muscles or local centres, or diminished power of the higher 

 co-ordinating centres. As a rule, it is due to diminished 

 action of the co-ordinating or inhibitory centres, rather than 

 to excess of action in the motor centres. It is, therefore, a 

 disease rather of debility and deficient co-ordination than 

 of excessive strength. Local irritation is frequently the 

 cause of spasm. 



Excessive exertion develops in the muscles of locomotion, 

 especially when employed in unwonted work, waste products, 

 which produce spasm or cramp. Both cause and effect are 

 frequently removed by smart friction. In the intestine, 

 cramp may be due to the presence of a local irritant, which 

 ought, in the normal condition, to produce increased peri- 

 stalsis, and thus ensure the speedy removal of the offending 

 substance. ' From some abnormal conditions, the muscular 

 fibres around the irritant contract excessively, and do not 

 pass on the stimulus to those adjoining. From this want of 

 co-ordination, painful and useless spasm occurs. In order 

 to remove it we apply warmth to the abdomen, so as to 

 increase the functional activity both of the muscular fibres 

 and of the ganglia of the intestine. Peristalsis then occur- 

 ring instead of cramp, the pain disappears, and the offending 

 body is passed onwards and removed. Or we give, inter- 

 nally, aromatic oils, which have a tendency to increase the 

 ordinary peristalsis ; or, yet again, we may give opium or 

 other anodyne for the purpose of lessening the sensibility of 



