TETANL'S LOCKJAW. 



features fixed in a ghastly grin. The tongue is apt to get between the teeth, and to 

 be severely bitten. The contractions are often attended with intense pain, which is 

 worse during the paroxysm, and extends over the whole body. With all this 

 disturbance of the muscular system there is commonly very little derangement of 

 the other functions of the body. The intellect is not affected, and the patient is 

 painfully alive to the critical nature of his condition. Death at length closes the 

 scene, the release being due partly to suffocation, and partly to exhaustion. 



The tetanic symptoms may come on at any time after the receipt of the injury, 

 from a few hours to a couple of weeks. After the disease has set in, its rate of 

 progress is very variable, but death is most likely to occur between the third and 

 fifth days. If the patient survive the ninth day of the disease, his prospects of re- 

 covery are much more favourable, and the spasmodic symptoms may gradually abate 

 ;iml disappear. When the spasm is not violent, when the paroxysms are short, and 

 recur at long intervals, and when the patient is able to sleep, we may hope for a 

 favourable termination. In traumatic cases the longer the disease delays its assaults 

 after the receipt of the injury, the milder, in general, does it prove. 



There is no difficulty in recognising the existence of tetanus. There is no 

 other disease for which it could be mistaken, with the exception, perhaps, of that 

 wonderful complaint hysteria, which may simulate almost anything. The symptoms 

 produced by poisonous doses of nux vomica, or its active principle, strychnia, are, 

 however, almost identical with those of tetanus, and it is well-nigh impossible to 

 distinguish between them. When a large poisonous dose of nux vomica is 

 administered death either rapidly ensues or the symptoms decline, and recovery 

 takes place. Nux vomica may, however, be given in small doses, frequently 

 repeated and gradually increased so as to imitate exactly the phenomena of tetanus 

 from natural causes. 



We will now speak of the treatment of tetanus. The patient must be put to 

 bed, and should be kept as quiet as possible. The slightest touch, a breath of cold 

 air, or the slamming of a distant door will often excite a paroxysm. Nothing 

 proves more injurious than meddlesome nursing. We have as yet no specific for 

 tetanus, and it is consequently impossible to speak dogmatically as to its treatment. 

 We can do little more than enumerate the remedies from which most benefit has 

 been derived. The drug on which we place most reliance is Calabar bean. To do 

 any good it must be given in large doses, but we can hardly recommend its adminis- 

 tration except under the personal superintendence of a doctor. Large doses of 

 chloral sometimes do good, and even when this remedy fails to effect a cure it often 

 prolongs life and eases the pain. The inhalation of nitrite of amyl might do good. 

 Gelseminum (Pr. 41) has been warmly praised in the treatment of tetanus, and 

 several cases are recorded in which recovery has followed its administration. The 

 application of an ice-bag to the spine, a measure which has been found extremely 

 useful in convulsions, is well worthy of a trial. The spinal ice-bag was described 

 when speaking of sea-sickness (see SEA-SICKNESS). The continuous administration 

 of chloroform has in some cases proved beneficial. In tetanus resulting from 

 injury it is very necessary that the wound should be carefully examined to see 

 whether by chance any foreign substance may not have been left in the wound. 



