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be swallowed, they are to be given in an injection. H 

 advises also to give hiera in an injection. 



Caelius Aurelianus (loco cit.) enumerates nearly th 

 same causes as Aretaeus, and describes all the symptom 

 of the disease with the greatest precision. His treatrnen 

 is also nearly the same as that of Aretaeus, namely, emol 

 lient applications to the neck, venesection, and oily clys 

 ters. He even enjoins the bath of oil, which has fallen 

 into disuse in modern practice, most probably solely or 

 account of the expense with which it would be attended 

 He also permits sometimes to use the common bath, bu 

 not of cold water. He allows wine in certain cases. Hi 

 condemns Hippocrates for giving both wine and emetics 

 and havinsr recourse to venesection, without due discrimi 

 nation. He blames him also for recommending the att'u 

 sion of cold water, inasmuch as he himself had pronouncec 

 cold to be injurious to the nerves, bones. &c. Galen how- 

 ever remarks, in his Commentary upon this aphorism o 

 Hippocrates 'sect, v. f 21 1, that cold in this case is not the 

 direct cause of the benefit derived from this remedy, but 

 'if I understand him right) that the shock which it imparts 

 to tht> system proves beneficial by rousing the vital heal 

 and energies of the patient. Hippocrates however, a* 

 stated above, forbade the cold affusion in traumatic teta- 

 nus. Paulus /Egineta's opinion of this practice is jusl 

 such as the profession in general now entertains, after it 

 has received another trial upon the recommendation of the 

 late Dr. Currie. (See Medical Reports, and Larrey's Mc- 

 moires de Chirtirgie, t. 1.) 



Octavius Horatianus (loco cit.} recommends bleeding, 

 emollient applications, purgative clysters, the tepid bath, 

 ant i spasmodic?, and soporifics. The use of the last-men- 

 tioned class of remedies does not appear to have been suf- 

 ficiently understood by the antients; at all events they 

 were less partial to them in this case than the modems. 



The Arabians enjoin nearly the same treatment as the 

 Greeks. Avicenna (loco cit.) and Mesue join the preceding 

 authorities in recommending strongly the use of castor and 

 assafoetida as antispasmodics ; and yet it is deserving ot 

 remark that modern surgeons do not repose much confi- 

 dence in these medicines. (See Sir James M'Grigor's com- 

 munication in the Medico-Chirurg. Transact., vol. vi. 

 Avicenna, like all the others, praises the bath of oil. Se- 

 rapion (lib. i., c. 27) speaks of a bath prepared with emol- 

 lient herbs. Haly Abbas (Theor., lib. ix., cap. 10, 11 ; 

 Pract., lib. v., c. 31) describes minutely the two varieties 

 as occasioned by repletion or inanition. For the former, 

 he approves of punring with hot drastic purgatives, of 

 rubbing the part affected with hot oils, and of using the 

 warm bath with friction after it ; he also approves of castor. 

 For the other variety he praises the affusion of plain water 

 in which lettuces, barley, &c. have been boiled. He re- 

 commends the internal use of milk and other demulcents, 

 and the bath of oil, and rubbing the body with oil of violeta. 

 The treatment recommended by Alsaharavius (Pract., 

 lib. i., 2, c. 211 is very similar. Rhazes mentions (/Jirix., 

 lib. i., c. 16 ; Contin., lib. 1) Hippocrates' proposal of the 

 cold affusion ; but, like Paulus ^Egineta, he rather disap- 

 proves of it. He himself recommends bleeding, when 

 there are symptoms of repletion, emollient applications to 

 the neck, the bath of oil, the application of leeches to the 

 part affected, purging with aloes, &c., and the adminis- 

 tration of antispasmodics, such as castor, assafoetida, and 

 the like. 



The 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 exists, and 

 of tranquillizing the nervous erethism of the entire system. 

 The former of these two objects is of great importance in 

 the locked-jaw, or trismus, of infants ; for, by removing 

 the viscid and acrimonious meconium, or whatever other 

 irritant is lodged in the stomach or bowels, we can some- 

 times effect a speedy cure without any other medicine. 

 Castor oil is by far the best aperient on this 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 anodynes: 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 cases 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 their only reliance. To give it a 



fair chance of success, we must begin its use from the 

 earliest appearance of tetanic symptoms. It must be 

 given in very large doses ; and these doses must be re- 

 peated at such short intervals as to keep the system con- 

 stantly under the influence of the remedy. It is astonish- 

 ing to observe how the human body, when labouring 

 under a tetanic disease, will resist the operation of this and 

 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 drops 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 spasms. In the 

 early stage of the disease we are to bear in mind the ap- 

 proaching closure of the jaw and difficulty of deglutition ; 

 and our remedies are accordingly to be pushed before such 

 serious obstacles to their administration arise. When they 

 have occurred, and are found to be insuperable, opiate 

 cnemata and frictions may be tried ; but we must not an- 

 ticipate much benefit from such feeble means. Such are 

 Dr. Gregory's remarks ; but Dr. Symonds considers that 

 the employment of opium is recommended chiefly by sys- 

 tematic 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 much more efficient class of remedies than 

 the preceding is that of purgatives; both on account 

 of the obstinate costiveness which attends the disease, and 

 also because we have in daily practice such convincing 

 proofs of their strong revulsive influence on diseases of the 

 cerebro-spinal centre. The testimony of the army phy- 

 sicians, 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 doses 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 suf- 

 ficient 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., vol. vi., 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 recom- 

 mended by numerous writers, but it would be difficult to 

 trace in their accounts any facts which decidedly show that 

 ts adoption was ever followed by unequivocal benefit. 

 C!old bathing has also been advised, but it has generally 

 >een found to be worse than useless ; and there are several 

 cases upon record of almost instant death having followed 

 ts employment. 



The practice of bleeding is another that has been tried, 

 )ut most frequently without effect. In some few cases 

 amputation of the limb, from the injury of which the teta- 

 uis has arisen, has been successful ; but as this extreme 

 measure is also very uncertain, it is not likely to be ever 

 extensively adopted. 



Numerous other remedies have been tried, with no, 

 or very imperfect, success ; for instance, acupuncture, 

 trychnia, mercury, caustics, blisters, tobacco, oil of tur- 

 >ehtine, aether, camphor, musk, bark, wine, sesqui-oxide 

 >f iron, &c. &c. However, it must, after all these have 

 >een tried, be confessed that tetanus is one of the most 

 brmidable and unmanageable of disorders, and that re- 

 jovery in the acute form still continues to be almost hope- 

 ess. 



(Cooper's Surgical Diet. ; Symonds, in the Cyclop, of 

 'ract. Med. ; Good's Study of Med. ; Gregory's Theory 

 and Practice of Med.; from which works most of the pre- 

 eding remarks have been taken. A reference to nu- 

 merous other works on the same subject will be found in 

 'loucquet's Liter. Med. Digetta ; Cooper's Surg. Dirt. ; 

 nd Forbes's Medical Bibliography, in the Cyclop, of 

 *ract. Med.} 



TETBURY, an antient market-town in Gloucestershire, 

 ear the borders of Wiltshire, situated on elevated ground 

 iear the source of the Warwickshire Avon, 99 miles west by 

 lorth from London, and 20 miles south-east of Gloucester, 

 'he parish, with four hamlets, contains a population of 



2K2 



