171 



TETANDS. 



TETRACIIORD. 



171 



certain mttiqimtitin U also requisite, and it is doubtless the same with 

 t which operate* a* an acwswry came of the traumatic tetanux. 



Th* predisposition to tetanic affections is riven, in the first place, by 



n tL.vr A . ^ . -i * 



that 



warm climates and warm seasons. Within the tropic* therefore it 

 prevail* to an extent unheard of in colder latitudes. Secondly, tetanus 

 fa chiefly observed to prevail when the atmosphere it much loaded 

 with moisture, and particularly where this hat suddenly succeeded to a 

 long eoune of dry and sultry weather. Even in this country exposure 

 loth* cold and damp air of the night hat occasionally been followed by 

 an attack of tetanus. In tropical climates children are particularly 

 subject to this complaint, and with a few peculiarities which, though 

 producing no specific difference, have been thought sufficient to con- 

 stitute a variety known by the name of trim*! naxtntlum. _ The 

 il'main in this caw is vulgarly known by the absurd name of falling of 

 tktjatc. It occurs chiefly between the ninth and fourteenth day after 

 birth, and seldom after the latter period. Without any febrile acces- 

 sion, and often without any perceptible cause _ whatever, the infant 

 sinks into an unnatural weariness and drowsiness, attended with 

 frequent yawnings, and with a slight difficulty of moving the lower 

 jaw. This last symptom takes place in some instance* sooner, in 

 others later, and soon increases in intensity. Even while the infant is 

 yet able to open its mouth, there is occasionally an inability to suck or 

 swallow. By degrees the lower jaw becomes rigid, and totally 

 resists the introduction of food. There is no painful sensation, 

 but the skin assume* a yellow hue, the eyes appear dull, the spasms 

 often extend over the body, and in two or three days the disease proves 

 mortal. 



The prognosis of this disease is mainly to be determined by the 

 nature of the exciting cause, and by the type of the seizure. Tetanus 

 of the idiopathic kind has certainly been cured in a larger proportion 

 of cases than that which follows external injury. The type of k the 

 I^I^MUMI as acute or chronic is a no less important guide as to the 

 probable termination. It may be said that recovery in a case of acute 

 tetanus is almost, if not altogether, hopeless : the chronic form, how- 

 ever, is of a much milder character. The usual termination of the 

 dinciaiin may be stated to occur on the third or fourth day; and if 

 tbe patient survives that time, there are good hopes of his recovery ; 

 it is rarely protracted beyond the eighth day. Mr. Cooper, however, 

 mentions (' Surg. Diet. 1 ) that he had a patient (who had been wounded, 

 and suffered amputation of the thigh) who lingered five weeks with 

 chronic tetanus before he died. 



Tbe dissection of patients who have died of tetanus has thrown 

 little or no light upon the real nature of the complaint, as ia indeed 

 the case in almost all spasmodic or neuralgic disorders. Sometimes 

 slight effusions are found within the cranium, but in general no 

 morbid appearance whatever can be detected within the head. There 

 is always more or less of an inflammatory appearance in the oesophagus, 

 and in the villous coat of the stomach about the cardia. These 

 appearances, however, are common to a great number of diseases, and 

 are uniformly met with in every case of rapid or violent death. 

 Besides the redness and increased vascularity of these parts. Baron 

 Larrey found the pharynx and oesophagus much contracted, and 

 covered with a viscid reddish mucus. He also found numerous luui- 

 brici in the bowels of several of the patients who died ; but this, as 

 Mr. Cooper remarks, could only be an accidental complication, and not 

 a cause. In several rsnnn Dr. M'Arthur found the intestines much 

 inflamed; and in two of them a yellow waxy fluid, of a peculiar 

 offensive smell, covered their internal surface; but whether the in- 

 flammation was primary, or only a consequence of the pressure of the 

 abdominal muscles, which contract so violently in this disease, he is 

 unable to decide. (' Med. Chir. Trans.,' vol. vii, p. 475.) 



The treatment of tetanus is confessedly a subject of infinite difficulty, 

 at the disease frequently baffles every mode of practice, and, in certain 

 inttimtt*. gets well under the employment of the very same remedies 

 which decidedly fail in other similar cases. Upon the whole it will 

 probably be universally admitted that no effectual remedy for tetanus 

 has yet been discovered, as every plan has occasionally succeeded, and 

 every plan hat still more frequently failed. An excellent abstract of 

 th opinions of the ancient* on this point is given by Mr. Adams in his 

 Notes to Paulus JEgineta. 



Tbe general principle of cure, as Dr. Good remarks, is far more 

 easily explained than acted upon : it is that of taking off the local 

 irritation, wherever such exist*, and of tranquillizing the nervous 

 erethism of the entire system. The former of these two objects is 

 of gnat importance in tbe locked- jaw, or trismus, of infante; for, 

 by removing the viscid and acrimonious meoonium, or whatever other 

 irritant is lodged in the stomach or bowels, we can sometimes effect 

 a speedy cure without any other medicine. Castor oil is by far the 

 best aperient on thii occasion, and it may be given both by the mouth 

 and by injections. If this, however, do not succeed, we should have 

 recourse to powerful anodyne* : of these the best is opium, which 

 should be administered in doses of from three to five drops of the 

 tincture, according to the age of the patient. Opium has also been 

 more extensively resorted to in the eases of adults than almost any 

 other remedy ; and Dr. Good, Dr. Gregory, and others profess that it 

 is that on which they place their chief, if not then- only reliance. To 

 give it a fair chance of success, we must begin iU use from the earliest 

 appearance of tetanic symptoms. It must bo given in very large 



doses; and these doses must be repeated at such short intervals at 

 to keep the system constantly under the influence of the remedy. It 

 is astonishing to observe how the human body, when labouring under 

 a tetanic disease, will resist the operation of this snd other remedies, 

 which, in its healthy state, would have been more than sufficient to 

 overpower and destroy it. It is advisable to begin with fifty drop* 

 of laudanum, and to repeat this at intervals of two or three hours, 

 or even oftener if the urgency of the symptoms require it, until 

 some effect has been produced on the spasm*. In the early stage 

 of the disease we -are to bear in mind the approaching closure of 

 the jaw and difficulty of deglutition; and our remedies are accord- 

 ingly to be pushed before such serious obstacles to their administra- 

 tion arise. When they have occurred, and are found to be insuperable, 

 opiate enemata and frictions may be tried ; but we must not anticipate 

 much benefit from such feeble means. Such are Dr. Gregory 'B 

 remarks ; but Dr. Symonds considers that the employment of opium 

 is recommended chiefly by systematic writers, and for theoretical, 

 rather than for practical reasons ; while most of those who give the 

 results of their own experience express the greatest dissatisfaction with 

 the remedy. 



Probably a uiuvh wore efficient clans of remedies than the preced- 

 ing Is that of purgatives; both on account of the obstinate costive- 

 ness which attends the disease, and also because we have in daily 

 practice such convincing proofs of their strong revulsive influence on dis- 

 eases of the cerebro-spinal centre. The testimony of the army physicians, 

 as we learn from the report of Sir James M'Grigor, is highly in 

 favour of a rigid perseverance in the use of purgatives, given in 

 adequate doges to produce daily a full effect. Dr. Forbes states that a 

 solution of sulphate of magnesia in infusion of senna was found to 

 answer better than any other purgative ; and it was daily given in a 

 sufficient quantity to produce a copious evacuation, which was 

 always dark-coloured and highly offensive; and to this practice 

 he chiefly attributes in one severe case the removal of the disease. 

 (' Med. Chir. Trans.,' yoL vL, p. 452, quoted by Mr. Cooper.) Dr. 

 Good condemns drastic purgatives, forgetting apparently that mild 

 ones have no effect. Strong cathartics have indeed frequently proved 

 of great service, and none has higher repute than croton oil. 



The employment of the warm bath has been recommended by 

 numerous writers, but it would be difficult to trace .in their accounts 

 any facts which decidedly show that its 'adoption was ever followed 

 by unequivocal benefit. Cold bathing has also been advised, but it 

 has generally been found to be worse than useless; and there are 

 several cases upon record of almost instant death having followed its 

 employment. 



The practice of bleeding ia another that has been tried, but most 

 frequently without effect. In some few cases amputation of the limb, 

 from tbe injury of which the tetanus has arisen, has been successful ; 

 but as this extreme measure ia also very uncertain, it is not likely to 

 be ever extensively adopted. 



Numerous other remedies have been tried, with no, or very imper- 

 fect, success ; for instance, acupuncture, strychnia, mercury, caustics, 

 blisters, tobacco, oil of turpentine, ether, camphor, musk, bark, wine, 

 sesqui-oxide of iron, Ac., Ac. However, it must, after all these have 

 been tried, be confessed that tetanus is one of the most formidable and 

 unmanageable of disorders, and that the recovery in the acute form 

 still continues to be almost hopeless. 



TETRACHOKD, the Greek name for any part of the scale con- 

 slating of four notes, the highest of which is a perfect fourth to the 

 lowest. Thus in the common diatonic SCALE (we assume a knowledge 

 of this article throughout) we have the following totrachorda : 



CHEF, DBFO, EFOA, OABC, ABCD, BCD*, 



We despair of giving anything like a satisfactory account of the 

 Greek music ; not that we think the difficulty lies in the Greek writers, 

 but in the manner in which they have been treated. It was so 

 assumption that the nation which produced models such as the moderns 

 could not surpass in architecture, sculpture, and perhaps in painting, 

 was to be considered as necessarily possessed of a system of music 

 approaching to perfection. Their writers on the subject were to be 

 taken as having an agreement with each other, which was to be 

 detected and established, any apparent discrepancy, however evident, 

 notwithstanding. The numerical relations which were the objects of 

 inquiry in the settlement of the parts of the scale gave the subject the 

 air of an exact science ; and explanations which required tbe assistance 

 of the scholar, the mathematician, and the musician, wore undertaken 

 by persons who were deficient in one character, if not in two. The 

 consequence has been such a mass of confusion as the world never saw 

 in any other subject; writers whose undertakings required them to 

 say something, copying absolute contradictions from different other 

 writers ; others glad to adopt anything intelligible, whether true or 

 not ; others again, unable or unwilling to state the simplest facts of 

 their .own premises, so that their readers are not even made aware 

 which of the most remarkable opposite opinions they mean to adopt. 



We intend in the present article, without looking into any modern 

 writer, to draw from Ptolemy and Euclid, writers who are known to 

 be trustworthy on other subjects, all concerning the tetrachord that 

 we can find to bear the character of certainty and precision, and to be 



