LOOK-JAW. 447 



remarks " that the application of cold water to the surface has, in 

 many recorded instances, been of at least temporary benefit and 

 comfort; and in the West Indies, where the disease is common, the 

 cold affusion still continues to be the favorite expedient." Some 

 have recommended for tetanus the use of ice upon the spine, a remedy 

 which has been found eminently beneficial in convulsions. The ice 

 should be applied by means of friction upon the naked skin up and 

 down the spinal column and over the whole region of the back. 



Various authors have recorded the beneficial effects of warm- 

 baths in this disease. The Germans have in some cases used the 

 warm-bath with success. In Holland it has been a custom to 

 immerse the patient in warm baths of broth, in which he is kept 

 for five or six hours, at the same time having opium administered 

 to him. The warm-bath is doubtless a valuable remedy, but in 

 some cases of the disease, much benefit cannot be expected from it. 

 Used in alternation with the cold-bath, it is to be recommended. At 

 the expense of repetition, I must here remark that the warm-bath 

 must not be confounded with the hot, an error too often committed. 



The great principle to be kept in mind in the treatment of this 

 disease is, that tetanus is a spasmodic affection. The treatment, 

 therefore, must be of an anti-spasmodic kind. The more powerful 

 the remedy, the more effectual it will prove, provided it is not such 

 as to injure or depress the vital force. Facts plainly prove that of 

 all known anti-spasmodics, water is altogether the most powerful. 



As to the methods of using it, due caution should be used. It 

 is said, on the .best authority, that patients have been killed by 

 throwing two or three pailf uls of cold water over the body, almost as 

 quickly as if they had been shot in the l,iead. If a powerful measure 

 is to be resorted to, it should be done when the paroxysm is at its 

 height. Tepid or cold water is not likely to injure a patient under 

 such circumstances. It is only when the patient is in the opposite 

 extreme of the disease, that a cold application proves so dangerous. 



Plunging the patient into cold water, douching and all applica- 

 tions that tend to shock the system, have often proved beneficial in 

 quelling the tetanic paroxysm ; but passive cooling such as gives 

 no severe shock to the system is much safer and therefore to be 

 preferred. The tepid shallow-bath, prolonged and with wet-hand 

 friction, is to be highly recommended. It should be remembered, 

 however, that as the disease varies from a very slight to a most 

 severe and terrible one, so should the treatment be made to vary 

 accordingly. If a poor sufferer is so bent up with cramp of all his 

 voluntary muscles that he can only touch his head and heels to the 

 bed, be assured it is no boy's play to treat his case. To bring down 

 such spasms 'as make a man's muscles hard and stiff as a board, is 

 to be accomplished only by the most energetic means. If we know 

 how to manage the more severe cases, the lighter ones will be no 

 difficult task. 



