TETANUS. 



31 



phine, lest they produce caries or necrosis, although in many in- 

 stances they have become encased and occasioned no inconvenience. 



The question of amputation will be settled by considering the 

 liability of gangrene, the usefulness of the limb if retained, the age, 

 habits, and strength of the patient, and the means at hand for carry- 

 ing out the treatment. The latter consideration will justify more 

 numerous amputations in military and naval than in civil surgery. 

 The following circumstances make amputation necessary. 



When a limb is completely knocked off by a cannon-ball. If the 

 bone is shattered and the joint endangered it should be amputated 

 above the joint. 



When the femur is fractured; and the femoral artery or vein, or 

 the sciatic nerve is lacerated. 



When large joints are injured; but that of the elbow may often be 

 excised. 



When the main artery is wounded, and gangrene has commenced 

 and is spreading. 



TETANUS. 



Is a disease of the true spinal system and is manifested by spasm 

 and rigidity of voluntary muscles. 



When the muscles of the neck and face are affected, it is termed 

 Trismy^^ or locked jaw ; when the muscles of the front, Empros- 

 thotonos ; when the muscles of the back, Opisthotonos ; bending to 

 either side is termed Pleurothotonos. 



Tetanus may be either an acute or chronic disease ; the former is 

 the most frequent in occurrence, and most formidable to treat ; the 

 latter, apt to be partial, milder, and more subject to treatment. 



Traumatic tetanus follows a wound or injury, and is usually 

 acute; idiopathic tetanus is of spontaneous origin, and usually 

 chronic. 



Acute traumatic tetanus is more frequent in hot climates, and in 

 military practice, and may follow a slight bruise or puncture, espe- 

 cially if some nerve has been injured. Intestinal irritation and at- 

 mospheric changes predispose to the disease. 



The symptoms may appear in a ^qw hours, or in as many days ; 

 at first there is stiffness and soreness about the neck and face, the 

 contraction of the muscles causing a ghastly smile; swallowing and 

 mastication are difficult, the forehead is wrinkled, eyeballs are dis- 

 torted, nostrils dilated, and the grinning countenance is expressive of 

 horror. Respiration is rapid, the tongue protrudes, and saliva 

 dribbles ; the sphincters are usually contracted, perspiration is pro- 

 fuse and of a peculiar odour ; the pulse at first may be strong and 

 full, but soon iDccomes weak and indistinct. The mind is clear until 

 just before death, which generally takes place in a few days. 



Treatment. — The indications are to remove all sources of irrita- 



