386 GENERAL NEUROSES, OF UNKNOWN ANATOMICAL ORIGIN. 



aspect of the wound change, and should it become dry and pain- 

 ful, we may already fear great danger to the patient. When the 

 disease has fairly set in, the head at first is almost always fixed and 

 drawn backward, by rigid contractions of the muscles of the neck. 

 Tonic spasms of the muscles of mastication press the jaws firmly 

 together (lockjaw, trismus), and at the same time deglutition is im- 

 peded or prevented by spasm of the pharynx. From the nape of the 

 neck the disease extends over the muscles of the back. Thus the 

 entire body is bent backward in the shape of a bow. The abdominal 

 and thoracic muscles, however, are also involved in the spasm. Hence 

 the belly is tense, contracted, and hard as a board, and there is a sense 

 of constriction at the pit of the stomach, which is very painful to the 

 patient. More rarely the muscles of the extremities, particularly those 

 of the forearms, legs, hands, and feet, are attacked by cramps. The terms 

 opisthotonos, emprosthotonos, audpleurosthotonos, are severally applied 

 to the disease, according as the contractions preponderate in the poste- 

 rior muscles of the neck and back, in the anterior muscles of the neck 

 and trunk, or in those of the side, and according as the body is drawn 

 forward, backward, or sidewise. When there is no such preponderance, 

 so that the body lies rigid as a statue, the condition is called orthotch 

 nos. Opisthotonos is by far the most common form of the malady ; 

 the other varieties are rare. The contracted muscles remain upon the 

 stretch throughout the whole disease. From time to time, however, 

 paroxysms occur, in which the cramps are so severe that the muscles 

 sometimes are torn asunder. At such times the middle of the body iu 

 suddenly jerked into the air, so that no part of it touches the bed ex- 

 cept the head and heels. The muscles are hard as stone, and are the 

 seat of frightful pain, which can generally be compared to that of a 

 severe cramp of the leg. The contours of the temporal and masseter 

 muscles stand out in bold relief, imparting a peculiar expression of 

 countenance. This is still further increased by contractions of the 

 mimic muscles of the face. The forehead is wrinkled, the brows knit, 

 the eyes rigidly fixed, and sunken deep into their sockets. The angles 

 of the mouth are drawn outward, and the lips are drawn apart, expos- 

 ing the clinched teeth. The muscles of the extremities are affected 

 last ; this is an important point in diagnosis. At the outset of the 

 disease the paroxysms do not occur spontaneously, but are provoked 

 by the most trifling causes. Just as in a frog poisoned by strych- 

 nine, in which tetanic spasms may be induced by merely tapping upon 

 the table on which he lies, so the slightest touch upon the skin or 

 breath of air upon it, a faint jolt of the bed, the sound of shutting 

 a door, every movement which a patient desires to make, the acts 

 of chewing or swallowing, or even the suggestion of the idea, suf- 



