LOCKED-JAAV, OR TETAXUS. 135 



It is universally acknowledged that injuries, as cuts, punc- 

 tures, surgical operations, whether properly or improperly per- 

 formed, the driving of nails into the sensitive parts of the foot 

 in shoeing, etc., may be followed by tetanus. Nor does the ex- 

 tent of the injury appear to make much difference, the slight- 

 est puncture often being followed by it. JN'either does the de- 

 gree nor extent of inflammation seem to have much to do in 

 the case. The attack may come on soon after the injury, or 

 not until it has quite healed, and perhaps not for some time 

 after. 



But I think it equally true that tetanus often occurs without 

 any local injury — exposure to cold, as standing in the rain, 

 hitched to a horse-rack, after brisk exercise; being w^orked 

 until very hot and sweating, and suffered to stand in the wind 

 and become chilled. Fatigue and hunger may give rise to it. 



Some writers think that a derangement of the digestive 

 organs is always present, to produce such a degree of nervous 

 irritability as would cause tetanus to arise from such trivial 

 injuries as often seem to cause it. I am certainly of opinion 

 that there must be some derangement of the system, or of some 

 part of it, to make the very same injury produce tetanus in 

 one case, which, in a hundred other cases, under apparently en- 

 tirely similar circumstances, w^ould cause no inconvenience. 

 And this, I think, will be found located in the spinal cord, the 

 great nerve from which all the voluntary nerves are given off. 

 This nerve is supplied with its investing membrane and blood- 

 vessels, and hence is liable to irritation and inflammation, just 

 as the brain, from which it springs, is. Now, if a degree of 

 irritation exists in this cord, it is, necessarily, in a high state 

 of excitability, and a very sliglit disturbance of one of its 

 smallest branches would be reflected to it, and produce a most 

 powerful effect upon it. This I conceive to be the true cause 

 of tetanus: an irritation of the spinal cord, greatly exalting 

 its sensibility, so much so, that, from even the slightest disturb- 

 ance, its action may rise entirely above the control of the brain. 



