Volume 14
A dictionary of practical medicine, comprising general pathology, the nature and treatment of diseases, morbid structures and the disorders especially incidental to climates, to the sex, and to the different epochs of life. With ... prescriptions, ... bibliography ... formulae / [James Copland].
- James Copland
- Date:
- 1832-1858
Licence: Public Domain Mark
Credit: A dictionary of practical medicine, comprising general pathology, the nature and treatment of diseases, morbid structures and the disorders especially incidental to climates, to the sex, and to the different epochs of life. With ... prescriptions, ... bibliography ... formulae / [James Copland]. Source: Wellcome Collection.
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![according to its antecedent or associated and pe- culiar phenomena, certain special forms, which are described under the several heads of chorea, convulsions, epilepsy, hysteria, &c., and for each of which, in its several varieties, the treatment is fully described. It therefore remains only to state those general principles or indications which ex- perience indicates or contra-indicates, under cer- tain circumstances and morbid conditions with which spasm is generally allied. 27. It would appear from what has beenstated above, that one or other of the different forms of spasm is contingent upon, oris produced by, one or other of the following pathological states, — Ist, congestion ; 2ndly, inflammation; 3rdly, irritation caused by acid, acrid, or otherwise disordered secre- tions and excretions ; 4thly, a contaminated state of the circulating fluids ; Sthly, some structural lesion or injury affecting adjoining or remote nerves or the origins of nerves; 6thly, extreme exhaustion of organic, nervous, or vital power; 7thly, the excessive action of muscles, and the contraction of muscles independently of a co-ordinate or suf- ficient determination of volition to them; 8thly, punctures or other injuries of tendons, nerves, or fibrous membranes; Qthly, the irritation of the sexual or urinary organs; and ]0thly, two or more of these states conjoined. It will be seen, from a consideration of these antecedents, that spasm is most commonly a symptom of certain disordered or morbid conditions, to which attention should chiefly be directed in its treatment, and that it is only when produced as just indicated in the seventh and eighth of the above series of causes or circumstances, that spasm can be considered as a primary or idiopathic disease. (See arts. Tera- nus and Trismus.) 28. A. Congestion, in connexion with spasm, may be viewed both as an antecedent and associate of this latter condition. It may, moreover, be further associated, as with irritation or some structural lesion; and as long as these are in existence, so long may the spasm continue or recur, as various concurring causes may favour its return. The existence of congestion is often difficult to deter- mine ; for when the spasm implicates any part of the respiratory apparatus, or when it is so ge- neral as to give rise to convulsions, with or with- out loss of consciousness, the congestion which is then made manifest is more the result of the spasm than the cause of it. Congestion of the brain, or near its base, especially if consciousness be lost, and congestion of the lungs and cavities of the heart, are common effects of general spasm or convulsions, especially when any part of the respiratory passages is affected. Congestion may certainly exist in either organ antecedently to either spasm or convulsion, for it is frequently the cause of both; but the spasm may increase the congestion, and it may even be the cause of relaxing the spasm when the congestion becomes extreme. ‘This latter effect takes place chiefly in extreme congestion of the brain, when conscious- ness is lost; the congestion, in connexion with the circulation of imperfectly oxydised blood in the brain, both relaxing the spasm and permitting the renewal of air in the lungs. The more mo- derate congestion in these cases first occasions spasm or convulsions ; but when the congestion of unoxidised blood, increased by the convulsions, becomes extreme, then the spasms are relaxed Vou, Ill. | 849 and altogether resolved, and either natural respira- tion is resumed, or death takes place from the cessation of respiration, owing to the effect pro- duced by the congestion at the origins of the re- spiratory nerves. In cases of spasm, thus arising or thus associated, the treatment must be directed by the following intentions: namely, Ist, to dimi- nish or remove congestion by means which expe- rience has shown to be most efficacious in obtain- ing this object; 2ndly, to prevent the recurrence of this condition and its contingent effects. 29. a. Spasm depending upon or connected with congestion of any vital or important organ has been too generally treated by large vascular de- pletions, both general and topical. In young, robust, and plethoric persons, and when the spasms have been consequent upon the stoppage of accustomed discharges, both the one and other mode of depletion may be employed, but with extreme circumspection, more especially during the attack. In most even of these cases, local depletions are the safest and most efficacious ; for when the circumstances just mentioned as war- ranting the depletion are not manifestly present, or when the patient is of a nervous temperament, either the local depletion should be small, or it should be altogether dispensed with, and other means be chiefly confided in. When local de- pletions are indicated, cupping is the most bene- ficial; and when the loss of any blood is justly dreaded, then dry-cupping may be resorted to, The circumstances indicating depletions, as well as those contra-indicating them, require for their recognition great discrimination, guided by an enlightened experience, and are such, in their natures, complexities, and varied successions and associations, as to be estimated correctly only at the moment by the closely observing physician. When therefore there is any doubt as to the pro- priety of bloodletting, it will be preferable to resort to dry-cupping, and to emetics and purgatives, conjoined with stimulants and antispasmodies, — with these latter more especially when nervous energy is much reduced or originally weak. 30. b. Of emetics, especially when spasm is immi- nent, or when it attacks any part of the respiratory apparatus, the most energetic is the tinctura Lobelie, or Tinct. Lobel. Atherea, given with vinum ipecacuanha to ensure its emetic operation, or with sulphas zinci. When vital or nervous power is much reduced, it may be given with spiritus ammoniz aromaticus, or with camphor, When bloodletting is manifestly indicated, or when congestion of, or vascular determination to the brain is urgent, then depletions and deri- vatives, as mustard pediluvia, should precede the exhibition of an emetic; and the affusion of cold water on the head, or cold sponging, may also be practised, the emetic operation and the relaxation of spasm being often promoted by these means, When congestion of the liver is connected with spasm, local depletion or dry-cupping, or both, are often required, and then the preparations of colchicum may be given, at first in a large dose, either with or without an emetic conjoined, and afterwards relinquished for purgatives and anti- spasmodics. The operation of the first dose of colchicum should be carefully watched, particu- larly when large, and, if vital depression follow it, stimulating antispasmodics, as ammonia, cam- phor, valerian, &c., pers le The spasms or](https://iiif.wellcomecollection.org/image/b33285330_0014_0135.jp2/full/800%2C/0/default.jpg)
