SPASMODIC AFFECTIONS, 403 



of stiffness in the back part of the neck, which, gradually in- 

 creasing, renders the motion of the head difficult and painful. 

 As the rigidity of the neck comes on and increases, there is 

 commonly at the same time a sense of uneasiness felt about the 

 root of the tongue ; which, by degrees, becomes a difficulty of 

 swallowing, and at length an entire interruption of it. While 

 the rigidity of the neck goes on increasing, there arises a pain, 

 often violent, at the lower end of the sternum, and from thence 

 shooting into the back. When this pain arises, all the muscles 

 of the neck, and particularly those of the back part of it, are 

 immediately affected with spasm, pulling the head strongly 

 backwards. At the same time, the muscles that pull up the 

 lower jaw, which, upon the first approaches of the disease, were 

 affected with some spastic rigidity, are now generally affected 

 with more violent spasm, and set the teeth so closely together, 

 that they do not admit of the smallest opening. 



This is what has been named the Locked Jaw, and is often 

 the principal part of the disease. When the disease has ad- 

 vanced thus far, the pain at the bottom of the sternum returns 

 very frequently, and with it the spasms of the hind neck and 

 lower jaw are renewed with violence and much pain. As the 

 disease thus proceeds, a greater number of muscles come to be 

 affected with spasms. After those of the neck, those along the 

 whole of the spine become affected, bending the trunk of the 

 body strongly backwards ; and this is what has been named the 

 Opisthotonos. 



In the lower extremities, both the flexor and extensor muscles 

 are commonly at the same time affected, and keep the limbs 

 rigidly extended. Though the extensors of the head and back 

 are usually the most strongly affected, yet the flexors, or those 

 muscles of the neck that pull the head forwards, and the muscles 

 that should pull down the lower jaw, are often at the same time 

 strongly affected with spasm. During the whole of the disease, 

 the abdominal muscles are violently affected with spasm, so that 

 the belly is strongly retracted, and feels hard as a piece of 

 board. 



At length the flexors of the head and trunk become so strongly 

 affected as to balance the extensors, and to keep the head and 

 trunk straight, and rigidly extended, incapable of being moved 



2c2 



