THE TREATMENT OF DISEASES. 



TETANUS LOCKJAW. 



Tetanus is a disease the prominent feature of which is spasm. We medically 

 recognise two different kinds of spasm. In. one form, which we call tonic spasm, 

 there is a continuous contraction of the muscles, just as when you get cramp in the 

 calf of the leg. In the other kind, donic spasm, there are alternate contractions 

 and relaxations of the muscles, just as you get, for instance, in convulsions. In 

 tetanus the spasm is entirely tonic, the muscles being in a constant state of 

 contraction. 



Most cases of tetanus are caused either by exposure to cold and wet, or by bodily 

 injuries. Not unfrequeiitly both causes co-operate in producing the disease. When 

 it sets in spontaneously as it does sometimes or as the result of cold, it is called 

 idiopathic tetanus ; and when it comes on after a wound or injury we speak of it as 

 traumatic tetanus. In this country idiopathic tetanus is rare, nearly all our cases 

 baing traumatic. It is a curious circumstance that tetanus occurs much more fre- 

 quently in hot climates than in cold. In India tetanus is frightfully common, and 

 is a frequent cause of death after operations. 



Tetanus is lia.jle to follow injury of any kind, to any part of the body. It may 

 set in after the slightest scratch or wound, or after the most severe surgical 

 operation. The disorder more frequently supervenes upon injuries of the 

 extremities than of the trunk, head, or neck, and upon wounds made by puncture, 

 than upon other hurts. Penetrating wounds of the sole of the feet, such as may be 

 inflicted by treading on a nail, and injuries to the ball of the thumb, are more likely 

 than other injuries to be followed by tetanus. There is a prevalent opinion that 

 tetanus is very apt to arise from a cut between the first finger and thumb, but we- 

 are not aware that this has any foundation in fact. 



The symptoms set in suddenly, the muscles of the neck, jaws, and throat being 

 usually first affected. The patient experiences a difficulty and uneasiness in bending 

 or turning his head, and says he feels as if he had a sore throat and stiff neck. He 

 finds also that he is unable to open his mouth with his customary ease. At length 

 the jaws close, sometimes gradually, and sometimes it is said, quite suddenly with a 

 snap. In the majority of cases the disease begins in this way hence the origin of 

 the name lock-jaw. As the disease proceeds the remaining muscles, those of the 

 trunk, and lastly those of the extremities, become implicated. The spasm never 

 entirely ceases, except in some cases during sleep, but it is aggravated every quarter 

 of an hour or so, the increased cramp lasting for a few minutes and then partially 

 subsiding. When the big muscles of the back are chiefly affected they bend the 

 body into the shape of an arch, so that during a paroxysm the patient rests on 

 nothing but his head and heels. Sometimes it is the muscles on the front of the 

 body that are chiefly involved, and the patient is then bent forward till the head 

 and knees are almost in contact. Occasionally, though very rarely, the muscles 011 

 one side only are affected, and then the body is bent laterally. The suffering 

 caused by tetanic spasm is absolutely frightful to contemplate. The face becomes 

 deadly pale, the brows are contracted, the eyes are fixed and prominent, the nostrils 

 are dilated, the corners of the mouth drawn back, the teeth 'exposed, and all the 



