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MEDICINE. 



Practice. 



SECT. XII. Tetanus. 



Tetanus. By Tetanus, in its most extensive sense, we mean 

 a rigid contraction of any muscle or set of muscles ; 

 but it is usually Applied to a general condition of the 

 system, where all the muscles of the body, and espe- 

 cially those of the trunk, neck, and jaws, are in a per- 

 manently contracted state, so as to render the patient 

 almost incapable of motion, speech, and deglutition, 

 while the most acute pain is experienced in all the af- 

 tVctcd parts, and particularly about the pit of the sto- 

 mach and over the abdomen. The disease is some- 

 times principally confined to the jaws and the neigh- 

 bouring parts, when it is styled Trismus or locked jaw. 

 It usually commences with a decree of stiffness in the 

 back of the neck, with some difficulty in opening the 

 mouth ; to this succeeds the rigidity of the muscles of 

 the trunk, where it is often so violent as to bend the 

 body into the form of an arch, and it finally extends 

 to the extremities. The disease is aggravated by par- 

 oxysms, which are generally, but not always brought 

 on by some voluntary exertion, as by changing the 

 posture, or by swallowing, when the contractions be- 

 come much more forcible, and the pains more acute, 

 until the patient is carried off in one of these acces- 

 sions, exhausted as it were by his excessive exertions, 

 and worn out by the violence of his sufferings. The 

 exciting causes of the disease are of two kinds ; the 

 most frequent in this climate is a certain species of 

 mechanical injury, not productive of much pain, but 

 exciting a specific irritation, which, from some unknown 

 cause, affects the nerves so as to induce the disease. 

 Wounds of a nerve are perhaps the most frequent 

 cause, but laceration of a tendon is also said to excite 

 it ; and it is often observed to follow gunshot wounds 

 or surgical operations, in which large bones have been 

 divided ; in these cases it is generally supposed that a 

 loose splinter of bone has been left in the wound, that 

 a nerve has been torn, or perhaps included in a liga- 

 ture. The other class of the exciting causes of Tetanus 

 is even more obscure; it occurs principally in hot cli- 

 mates, and generally originates from those circum- 

 stances that are supposed suddenly to check the cuta- 

 neous perspiration, where the body is exposed to damp 

 and cold after great heat ; of these one of the most 

 frequent occasional causes is sleeping on the moist 

 ground, after violent exercise under a tropical sun. 

 It does not appear that the symptoms of the disease in 

 these two varieties are materially different, although 

 arising from such different causes; but those of the 

 latter kind, which are termed idiopathic, are, for the 

 most part, less violent than such as arise from wounds 

 or other mechanical injuries. Although fever is not 

 an essential symptom of the disease, yet after it has 

 subsisted for some time, the pulse becomes accelerated 

 and the temperature increased ; and it has been sup- 

 posed that the best means which we possess of form- 

 ing a prognosis is derived from the state of the pulse, 

 especially with respect to its velocity. 



Treatment In attempting the cure of Tetanus, the first object is 

 to remove the source of irritation, if it depends upon 

 any obvious mechanical cause ; if it proceeds from a 

 wound of any kind, it has been recommended to di- 

 vide the nerve which passes from the wounded part to 

 the brain ; but this practice .has not been attended 

 with the expected relief, nor has even amputation of 

 the limb been successful, when the disease has once 

 taken possession of the constitution. Applying caus- 



tics, or heating stimulants, as the oil of turpentine, to Practice, 

 the wound, so as to produce a copious suppuration in the '"""V"" 

 part, has been thought to afford a probable means of re- 

 lief, upon the principle that where Tetanus has followed 

 from a mechanical injury, the discharges have assumed 

 an unhealthy aspect. It is, however, extremely doubt- 

 ful whether any advantage has been derived from 

 these practices, and at all events our main reliance is 

 to be placed upon internal remedies, of which the 

 most important is opium. When the symptoms of the 

 disease unequivocally manifest themselves, we raust im- 

 mediately have recourse to this medicine in frequently 

 repeated doses; the extent of the dose must depend upon 

 the effect which it produces on the system; but the quan- 

 tity which has been taken in this disease is very large, 

 and much more than could have been borne in the or- 

 cl'nary condition of the functions. Many substances 

 have been united with opium, upon the idea of increas- 

 ing its efficacy, but it may be questioned whether they 

 are of any essential benefit ; perhaps indeed in those 

 cases where there is much fever, a combination of 

 opium and ipecacuanha may be preferable to opium 

 alone. Some cases are upon record where idiopathic 

 Tetanus has been relieved by dashing cold water over 

 the patient, or by immersing him in the cold bath, but 

 this has probably been in the slighter cases only, and 

 in Tetanus from wounds has been found completely 

 useless, perhaps even injurious; for in such cases the 

 sensations of the patient rather indicate the application 

 of warmth than of cold to the surface. Besides the in- 

 ternal exhibition of opium, it has been found to pro- 

 duce its appropriate action on the system, by being 

 rubbed on the skin in the form of ointment; when the 

 process of friction does not add to the sufferings of the 

 patient, this will at all times be found a useful adjunct 

 to the internal exhibition of the remedy ; and where 

 the deglutition is very much impeded, we are under the 

 necessity of entirely depending upon it. Mercury, 

 which in modern times has been regarded by some au- 

 thors as a universal panacea for all complaints, has 

 been employed in Tetanus, and as we are informed, 

 with the usual success ; but it has not produced the 

 same good effect in other hands. Wine or ardent spi- 

 rits, taken in large quantities, has been recommended 

 in Tetanus, and some cases are upon record where this 

 plan has appeared to be successful ; but, upon the 

 whole, we think it is less effective than opium, and we 

 perceive no motive for preferring it. Purgatives in 

 this, as in all the Neuroses, are valuable adjuncts to our 

 other remedies, but in Tetanus we are not to depend 

 upon them as affording a radical means of cure. 



SECT. XIII. Colica. Colic. 



Perhaps the only idiopathic disease which can be Colica. 

 considered as belonging to the next genus of the 

 Spasmi, those which consist in an irregular action of 

 the involuntary muscles, is Colica. Colic consists in 

 pain of the bowels, especially characterized by a twist- 

 ing sensation in the umbilical region, accompanied 

 with spasmodic contraction of the abdominal muscles 

 and obstinate costiveness. There are many varieties of 

 Colic, which are clearly referable to different exciting 

 causes, but which nearly resemble each other in their 

 symptoms: the peculiar state of the digestive organs, 

 and of the biliary secretion ; various articles of food, or 

 merely an excessive quantity taken into the stomach ; 

 retention of the faeces ; the application of cold and 

 moisture to the feet; perhaps worms; and certain me- 



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