TETANUS. 375 



In those cases of Tetanus where the jaws become firmly 

 closed, recovery from the disease is rare. 



The more rapidly the disease supervenes upon the infliction 

 of an injury the more acute it generally is, and the more destruc- 

 tive in its results. 



The period of the duration of the disease, in fatal cases, is 

 jfrom a few hours to fourteen or even twenty-one days. 



When recovery takes place the duration of the disease is 

 generally from four to six weeks. 



Fever is not a necessary attendant upon Tetanus. In many 

 of the worst forms of the disease I have found the pulse scarcely 

 disturbed, unless the patient was unduly excited. 



Tetanus is a remittent disease. In cases which tend to a 

 favourable result, the paroxysms of spasm less and less fre- 

 quently occur, and are less and less severe, until in the end 

 they entirely cease, and the patient recovers. 



Tetanus is presented in a threefold form, viz. : — as an acute, 

 sub-acute, and chronic disease. It is from the sub-acute and 

 chronic forms that the greatest number of tetanic cases recover. 



The time at which Tetanus may appear after the infliction 

 of an injury varies from a few hours to even three weeks. From 

 three to ten days, however, appears to be the average period. 



Symptoms. — The symptoms of Tetanus may be arranged 

 into three classes. First — symptoms of the early or incipient 

 stage of the the malady ; second — of the middle or sub-acute 

 stage ; and third — of the acute, or last stage. In every case of 

 Tetanus which ends fatally, the most acute stage of the disease 

 is the last. The patient is generally in the end destroyed from 

 its excessive active violence. The most acute stage may set in 

 at once, or follow so quickly upon the first as to have prevented 

 the first from being noticed. Should the first stage of the 



