T E T 



249 



T E T 



defined to be a more or less violent and rigid spasm of 

 many or all of the muscles of voluntary motion ; the name 

 is also particularly applied (as will be seen hereafter) to 

 one of the species of this affection. Both the disease and 

 also its name are as old as the time of Hippocrates ; and, 

 as it is proved by experience to be much more frequent in 

 warm climates, the antient physicians probably had pecu- 

 liar advantages in observing it, and accordingly seem to 

 have paid particular attention to it. The following de- 

 scription by Aretaeus (De Cans, et Sign. Morb. Acut., 

 lib. i., cap. 6, p. 6, ed. Kiihn) is written in his usual graphic 

 style. (The translation by Dr. Reynolds has been chiefly 

 followed.) 



' Tetanic spasms,' says this author, ' are attended with 

 severe pain, and prove rapidly fatal, and by no means 

 readily admit of relief; they make their attack on the 

 muscles and tendons of the jaws and neck, but impart the 

 disease to every other spot, for all parts become sympathe- 

 tically affected with those which were primarily assailed. 



' There are three forms of the convulsions : the straight, 

 the backward, and the forward. The straight one is true 

 Tetanus, when the patient is stretched straight and inflexi- 

 ble ; the backward or forward varieties have their name 

 from the direction and locality of the tension ; hence the 

 deflexion of the patient backwards is termed opisthotonos 

 (tnrtireoTovos), 'from the nerves being affected in this direc- 

 tion ; while, if the bending be forward, by the nerves in 

 front, it is termed emprosthotonos (iuirpo<r6oTovos), for tonos 

 (TOVOS) is a term which signifies both a nerve and tension. 



' The causes of these affections are numerous : they often 

 follow a wound of a membranous part, or punctures in 

 muscles or nerves, and in such cases the patients usually 

 die, for (as Hippocrates says, Aphor., sect, v., $ 2, torn, iii., 

 p. 735) " traumatic spasms are fatal." A woman may be 

 convulsed after miscarrage, and she seldom recovers ; some 

 persons are seized with spasms from a violent blow on the 

 neck ; intense cold may prove a source, and hence these 

 diseases are particularly liable to occur in the winter; they 

 are less frequent in the spring and autumn, and least of all 

 in the summer, unless they arise from a wound, or a visita- 

 tion of foreign diseases. Women are more liable to con- 

 vulsions than men, because they are of a colder tempera- 

 ment, but they more frequently recover, from the moisture 

 of their temperaments. 



' As respects the various periods of life, children are liable 

 to this affection, but do not. often die, for it is one they 

 are used to, and familiar with ; youths are less frequently 

 affected, but more die ; adults are least of all liable to be 

 attacked ; while the old have it, and die from it, more 

 than any other class of persons : the cause is referrible to 

 the frigidity and dryness of old age, which is also the 

 nature of death, for, if the cold be attended with mois- 

 ture, the spasms are less injurious and fraught with less 

 danger. 



' It may be said in general of all these affections, that they 

 are attended with pain and tension, both of the tendons 

 and spine, and of the maxillary and thoracic muscles ; for 

 they so clench the lower jaw to the upper, that it is not 

 easy to separate them either by lever or wedge ; and if, 

 on forcibly separating the teeth, any liquid be introduced, 

 it is not swallowed, but returned, or retained in the mouth, 

 or ejected through the nostrils, for the passage of the 

 fauces is closed, and the tonsils, being hard and tense, do 

 not collapse so as to depress the food in swallowing. The 

 face is red and mottled, the eyes nearly fixed, turned with 

 difficulty round, there is a strong feeling of stifling, respira- 

 tion laboured, the arms and legs on the stretch, the muscles 

 quivering, the face distorted in all sorts of ways, the cheeks 

 and lips tremulous, the chin in constant motion, the teeth 

 grate, and sometimes the ears will move, as I have myself 

 witnessed with amazement : the urine is cither retained 

 with violent pain, or flows off involuntarily from compres- 

 sion of the bladder. These appearances are common to all 

 the species of spasms ; each variety of this disease has 

 however its pecularities. 



In ti'tinni* the whole body is stretched in a right 

 line, rigid and immovable, while the legs and arms are 

 straight. 



' In opixthotnnnit the patient is bent back, so that the 

 head pulled in that direction lies between the shoulder- 

 blades, while the throat projects ; the lower jaw is usually 

 open, and is rarely locked with the upper ; the respiration 

 is stertorous, the abdomen and thorax are prominent, and in 

 P. C., No 



this form especially there is incontinence of urine ; the 

 epigastrium is tense and resonant when struck, the arms 

 are forcibly wrenched back in a state of tension, while the 

 legs lie bent together, for the elbow bends in a manner the 

 reverse of what the ham does. 



' If emprosthotonos take place, the back is bent, the hips 

 are forced on a level with the shoulders, the whole spine 

 is on the stretch, the head is dependent and bent on the 

 chest, the chin fixed upon the sternum, the arms cramped 

 up, and the legs at full stretch. The pain is severe in all 

 the forms, and wailing is the voice, deep are the sobs and 

 groans, and if now the disorder has assailed the chest and 

 respiration, it soon hurries the sufferer off a boon indeed 

 to him, as it relieves him from pain, distortion, and 

 humiliation, and serving also to lighten the distress of 

 those present, even if they be his own father or son ; but 

 if there be still respiration enough to support life, and 

 although oppressed it be still performed, the patients are 

 not merely bowed forward, but are even rolled up like a 

 ball, so as to have their head on their knees, and their legs 

 and back parts wrenched forward, so as to look as if the 

 knee joint were thrust into the ham. It is an affliction 

 more than man can bear, a sight revolting and painful to 

 behold ; and this cruel disease is irremediable, and from 

 the distortion the sufferer is not recognised, even by his 

 dearest friends, and the prayer of those around (which 

 would have been heretofore impious, but hath become 

 now righteous) is, that the wretched sufferer may depart 

 out of life, and be released at the same time from his 

 existence, pain, and horrible torment ; and the physician, 

 though present and looking on, is not merely unable to 

 save his life, or to give relief to his pains, but he cannot 

 even improve his shape ; for to attempt to straighten the 

 limbs would be like mangling and breaking the man in 

 pieces while yet alive, and therefore, no longer offering his 

 assistance, he is reduced to the sad necessity of merely 

 contributing his sympathy.' 



The three forms of the disease mentioned by Aretaeus 

 are described by most of the antient writers : the species 

 ca!led trt'smtis, or locked-jaw (which is the name applied 

 to it when the spasms are confined to the muscles of the 

 jaw or throat), forms a fourth in modern authors ; and to 

 these has been added a fifth, under the name Pleitros- 

 thotonos (Tr\evpoa8oTovof}, which signifies that the body is 

 drawn to one side. These different terms applied to 

 tetanic affections do not imply so many particular 

 diseases, but only the seat and various degrees of one 

 and the same complaint. Trismus is invariably a part of 

 each of the other varieties. This subdivision of the disease 

 is of little or no practical importance ; but a much more 

 essential division is into acute or chronic, according to its 

 greater or lesser intensity. The former kind is exceedingly 

 dangerous and usually fatal ; while the latter, on account 

 of the more gradual progress of the symptoms, affords 

 more opportunity of being successfully treated. (Larrey, 

 in Mem. de Chtrurgie Militaire, tome i., pp. 235, 236, 

 quoted in Cooper's Diet, of Pract. Surgery.} Tetanus is 

 also divided into traumatic, or that arising from a wound, 

 which is also occasionally termed symptomatic; and into 

 idiopathic, or that which proceeds from other causes. 



Traumatic tetanus sometimes comes on in a surprisingly 

 sudden manner, and quickly attains its most violent degree. 

 The most rapidly fatal case that has ever been recorded is one 

 that we have on the authority of the late Professor Robi son 

 of Edinburgh. It occurred in a negro, who scratched his 

 thumb with a broken china plate, and died of tetanus a 

 quarter of an hour after this slight injury. (Rees's Cyclo- 

 pcedia, art. 'Tetanus,' quoted by Cooper.) Most com- 

 monly however the approaches of the disorder are more 

 gradual, and it slowly advances to its worst stage. In this 

 sort of case the commencement of the disorder is an- 

 nounced by a sensation of stiffness about the neck, a 

 symptom which, increasing by degrees, renders the motion 

 of the head difficult and painful. In proportion as the 

 rigidity of the neck becomes greater, the patient expe- 

 riences in the throat a sense of dryness and soreness, and 

 about the root of the tongue an uneasiness, soon changing 

 into a difficulty of mastication and swallowing, which 

 after a time become totally impossible. The attempt at 

 deglutition is attended with convulsive efforts, especially 

 when an endeavour is made to swallow liquids ; and so 

 great is the distress which accompanies these convulsions, 

 that the patient becomes very reluctant to renew the trials, 



VOL. XXIV. 2 K 



