110 SIXTH REPOUT — 1836. 



with great minuteness, all the phaenomena of the disease, and the general 

 laws by which it is regulated, in order to show what constitutes genuine 

 tetanus; and, amongst other interesting facts, he mentioned that he has 

 seen the peculiar tetanic expression of the face retained for fourteen 

 years. (Here a lithographic representation of the face of a patient, 

 during and between the tetanic paroxysms, was exhibited to the sec- 

 tion) . 



He considered the singular alteration of the countenance to be the 

 only true pathognomonic sign of the disease, and declared the phseno- 

 mena and laws of this affection to be more uniform and definite than 

 those of any other. He considered that there were many strong reasons 

 for believing that the degree of general suffering which the patient 

 endures, is by no means so great as is universally supposed, or as the 

 external and very frightful characters of the malady would seem to in- 

 dicate. He then stated, that, after post-mortem examinations made in 

 several cases of opisthotonos, and which he knew to be genuine, the 

 only morbid or abnormal appearances were great distension of the 

 caecum and colon, and rigid contraction of the rectum ; but that in cases of 

 emprosthotonos, either the heart or lungs, or both of these organs, were 

 always found more or less diseased. He next showed the extraordinary 

 extent to which the disease has been confounded with injuries of the 

 temple, face, mouth, and pharynx, and with hysteria, rheumatism, 

 spinal irritation, spinal arachnitis, cynanche tonsillaris, and a peculiar 

 aifection to which he gave the name of, " pseudotetanus." He also 

 showed how satisfactorily the knowledge of such mistakes explained 

 numerous perplexing circumstances relating to the pathology and treat- 

 ment of the disease. 



Dr. O'Beime then described the difficulties which he had encoun- 

 tered in founding a correct pathology of tetanus, the means and steps 

 by which he was enabled to overcome those difficulties, and ulti- 

 mately to arrive at a satisfactory solution of those long contested and 

 unsettled points, the seat and nature of the maladj'. He placed its seat 

 in the substance of the anterior columns of the spinal marrow, and 

 showed that its nature is purely functional, and consists in either an 

 accumulated or a peculiarly intense condition of the motific principle 

 residing in the anterior spinal columns or pyramids, and perhaps their 

 prolongation to the optic thalami and striated bodies. But he considered 

 that an affection of the origin of the pneumogastric nerves is super- 

 added in cases of emprosthotonos. The remedial agents which he em- 

 ploys he stated to be tobacco, the gum-elastic tube, and croton oil, and 

 then mentioned the rules which should guide their employment, and 

 without a knowledge of which life might be sacrificed at the very mo- 

 ment of success. He next laid before the Section a tabular view of 

 twenty cases treated upon his plan, from which it appeared that eleven 

 had terminated in perfect recovery. From this document it also ap- 

 peared that, of the remaining nine fatal cases, one would have been 

 successful if the use of the tube had been known at the time, while in 

 six others it was found that the patients had laboured under organic 

 disease of either the heart or the lungs for a long period previous to 



