PATHOLOGY. 303 
2. Parapfis expers; total infenfibility toobje&s of touch. 
Divided into, 
a.. Simplex, numbnefs : confined locally or generally 
to the fenfe of touch ; fometimes accompanied with un- 
eafinefs. 
C. Complicata : complicated with infenfibility in feve- 
ral or all the other fenfes. 
3. Parapfis illuforia : imaginary fenfe of touch or ge¬ 
neral feeling in organs that have no exiftence. Common 
to thofe who have fuffered amputation. Found alfo, oc- 
cafionally as a fymptom, in hypochondriafis and other 
mental affeftions. 
Order III. Cinetica, from xinv , to move.] 
Diforders affe&ing the Mufcles. Irregular aftion of the 
mufcles or mufcular fibres; commonly denominated 
fpafm. This order contains four genera. 
Genus I. Entafia, [from eneiw, to ftretch.] Tonic 
fpafm. Irregular mulcular aftion, producing contrac¬ 
tion, rigidity, or both. There are feven fpecies. 
1. Entafia priapifmus, priapifm; fo called from Pria- 
pus, the fon of Venus and Bacchus, who is ufually thus 
reprefented in paintings and fculptures. Permanent 
rigidity and ereftion of the penis, without concupifcence. 
For the moft part the confequence of cold, cantharides, 
clap, or dyfury. It feems to arife from a fpafmodic con¬ 
traction of the ereftores penis, wholly unconnected with 
the Hate of fulnefs of the veficulae feminales. It is a dif- 
eafe of advanced life. Priapifmus affords a ftriking in- 
ftance of fpafm arifing from debility. Camphor and 
opium at night, with purgatives and diluents in the day¬ 
time, are the belt remedies; but we can in general only 
palliate ; the difeafe is feldom removed. 
2. Entafia loxia, ftiff-neck: permanent contraction of 
the flexor mufcles on the right or left of the neck, draw¬ 
ing the head obliquely in the fame direction. Three 
varieties. 
a. L. difpars; from difparity in the length of the 
mufcles oppofed to each other. 
0. L. entonica; from excefs of mufcular aCtion on the 
contracted fide. 
7. L. ato.nica; from direCt atony of the antagonifl 
mufcles. Found alfo, occafionally, as a fymptom, in 
fprains or inflammations of the neck; in catarrh ; and in 
contractions of the fkin of the neck from fevere burns. 
This and the following fpecies will require to have their 
treatment varied according to the exciting caufe; and, 
when not arifing from inflammation or injury, may be 
fubjeCt to the fame treatment as that which applies to 
atony of the mufcles in general. Thefe indications we 
fhall more particularly develope under our defeription of 
Tetanus. 
3. Entafia articularis, mufcular ftiff-joint: permanent 
and rigid contraction of one or more articular mufcles or 
their tendons. Three varieties, 
a. Entonica, articular fpafm ; from excefs of aCtion in 
the mufcles contracted. 
0. Atonica; from direCt atony of the antagonifl: muf¬ 
cles. 
7. Inufitata ; from long confinement or negleCt of ufe. 
Found alfo occafionally, as a fymptom, in articular inflam¬ 
mations, abfeefles, and ulcers fecreting an irritating fluid. 
4. Entafia trifmus, locked jaw : permanent and rigid 
fixation of the mufcles of the lower jaw. This has alfo 
three varieties. 
a. Tr. nafeentium; attacking infants during the firfl 
fortnight after birth. Probably the refult of acrimony in 
the ftomach. This is principally found in hot climates ; 
and refults occafionally from irritation in the digeftive 
organs, and in other cafes from the irritable ftate of the 
divided funis. As it is feldom cured when once formed, 
praClitioners in hot climates fliould be careful to keep the 
bowels open, and infpeCt occafionally the ftate of the fu¬ 
nis. 
0. Tr. trauniaticus; occurring at every age as the con- 
Vol. XIX. No. 1305. 
fequence of a w'ound, punCture, or ulcer; chiefly in hot 
climates. 
The following varieties of this, and of all the next fpe¬ 
cies, will be treated of together, as being of the fame 
nature, and differing in appearance merely from the pe¬ 
culiar mufcles affeCted. 
7. Tr. algidus; occurring after expofure to cold and 
damp, efpecially the dew of evening. 
5. Entafia tetanus: permanent and rigid fixation cf 
many or all the voluntary mufcles; with incurvation of 
the body, and dyfpncea. Four varieties. 
«. T. anticus, (Emprofthotonus, Aucl. var.) tetanus 
of the flexor mufcles : body rigidly bent backward. 
0. T. dorfalis, (Opifthotonus, Au6i. var.) tetanus of 
the extenfor mufcles : body rigidly bent forward. 
7. T. lateralis: tetanus of the lateral mufcles: body 
rigidly bent laterally. 
$. T. catochus: tetanus general, with little or no dif¬ 
ficulty of breathing ; chronic and periodical. 
Tetanus is very ltriddy a nervous malady. It follows 
mechanical or chemical irritations, under circumftances 
of high temperature or irritable habit of body, and fome¬ 
times without thefe circumftances. The irritations are 
of various kinds. The moft common is a wound, punc¬ 
ture, or bruife, particularly if a large nerve be wounded. 
Next in order come gaftric and internal irritations; and 
thefe are fo generally met with even when external in¬ 
jury exifts, that one might almoft infer that they always 
form a link in the chain of morbid aftion. Another 
caufe is put down in medical fyftems ; viz. the fudden 
application of cold to the heated body. From whatever 
caufe, however, the irritation arifes, its effefts are exerted 
in fuch a manner on the mufcular fyftem, as to produce 
a rigid and permanent degree of contraction. Unlike 
what is obferved in nervous difeafes in general, this dif- 
order does not abate when its original caufe is removed. 
If the limb be amputated on which the irritating wound 
has been inflicted, no relief follows. Hence it feems that 
the violence of the irritation in the firft inftancecaufes an 
aCtual difeafeof the nervous fyftem capable of exciting con¬ 
tinually mufcular aCtion. What this ftate may be we know 
not. It has been afferted, that it is inflammation of the 
fpinal marrow. The ftate of the vafcular fyftem does not 
bear out this affertion ; neither is it borne out by the 
mode of attack, which generally comes on firft in the 
jaw, a part not depending on the fpinal marrow for its 
nervous fupply. Moreover the effeCt of remedies does 
not bear out the above propofition ; the moft extravagant 
bleedings have often failed to procure relief; while fti- 
mulants have been fometimes fuccefsful. We (hould 
conclude, therefore, that tetanus is a difeafe which arifes 
from irritation of the extremities of nerves, which con- 
fifts in fuch a change of the nervous centres of motion, 
that they continually and exceflively maintain their fti- 
mulation on the mufcular powers ; and that, when this 
ftate of difeafe (when it may be) is induced, it goes on 
independently of the caufes which produced it. This 
explanation by no means involves the queftion, whether 
or not tetanus be fpinal inflammation : it only refufes to 
adopt the affirmative, on account of the paucity of dif- 
feCtions on which it is founded. 
The firft fymptom the attentive praflitioner remarks in 
tetanus, is a tranfient ftiffening of the limbs during fleep, 
and fometimes fpafmodic twitches. Another fymptom, 
which is only ufeful as indicating that tetanus is likely 
to occur, is fufpenfion of the alvine difeharges. The next 
fymptom is flight ftiffnefs in theback part of the neck and 
about the fhoulders, which, gradually increafing, impedes 
the rotatory motions of the head, and alfo its flexion for¬ 
wards : fo that the patient cannot look downwards, or to 
either fide, without turning his whole body. This un- 
eafy feeling, being chiefly felt on motion, very much re¬ 
sembles what occurs from rheumatifm, but it is accom¬ 
panied with a fenfe of general laflitude and debility. The 
rigidity now extends from the back of the neck to the 
4 I mufcles 
