TETANUS. 339 



symptoms, only held good in two of JSasse's cases, and that only at 

 the very commencement, and not after the manipulation had been con- 

 tinued. This circumstance and the relief which the baths afford to the 

 patients imperatively demand their employment. 



Upon the supposition that tetanus was an inflammatory affection 

 of the spinal marrow, the attempt was formerly made to fulfil the indi- 

 cation of the disease itself by blood-letting, local and general, and by 

 the exhibition of calomel to the point of salivation. Such procedures, 

 however, have been abandoned more and more in later times. Unfor- 

 tunately we do not possess any remedy capable of bringing back the 

 irritable state of the spinal cord to its normal condition. Even the 

 narcotics do not have this effect, although they are indispensable for 

 the purpose of alleviating the sufferings of the patient. To accomplish 

 this, large doses must be given ; so that, unless the approach of narco- 

 tism be vigilantly watched, there is danger of hastening the fatal 

 termination. If the patient cannot swallow, morphia should be given 

 hypodermically, or else clysters, containing twenty or thirty drops of 

 laudanum. Injections of tobacco are not of much greater service than 

 opium-clysters, and, unless the dose be regulated with extreme caution, 

 they are much more liable to give rise to a fatal collapse than the lat- 

 ter. The ansesthetics, if possible, are of still greater importance than 

 the narcotics ; but, unfortunately, their effects likewise are merely pal- 

 liative. Too free use of them must be avoided, and the patient must 

 not be kept in a state of permanent insensibility from chloroform. 

 The English recommend the stimulants, especially carbonate of ammo- 

 nia, brandy, and wine, to which they give much greater credit than to 

 blood-letting and the narcotics. Trustworthy observers have obtained 

 very great benefit from the hypodermic injection of a solution of curare 

 in tetanus. This treatment certainly deserves further trial. However, 

 owing to the very variable character of the curare, it will be necessary, 

 Drior to the exhibition of the preparation to be used, to ascertain, by 

 experiment upon animals or upon the healthy human being, how large 

 a dose may safely be administered. When this precaution has not 

 been taken, we must commence with very small doses (gr. -J to gr. ), 

 and gradually increase them to gr. % to gr. 1J. Demme advises that 

 a solution of one or two grains in one hundred drops of water be em- 

 ployed, ten drops of this to be injected as a dose. According to 

 Demme, the action of curare lasts four or five hours, and then begins 

 to abate ; and upon this fact the repetition of the dose may be reg- 

 ulated. It is most important that the patient should be kept in a 

 quiet chamber, with a uniform temperature, and that his eyes should 

 be screened from too bright a light. 



For the tetanus neonatorum we may prescribe camomile-baths, 



