138 



stone pavement, which circumstance, in conjunction with a 

 thin weak sole, and probably an acclivity of the floor of the 

 stall to stand against rather than upon, more fatiguing in its 

 effects than a moderate amount of ordinary labor, and I think 

 we have reasons, many and sufficient, for regarding a disordered 

 condition of the blood and nerves of the feet as a frequent 

 source of visceral irritation and per consequence, of many 

 cases of idiopathic tetanus. 



With such "concurrent or predisposing causes " in almost 

 perpetual existence to diseases of the nervous system, and to 

 'maladies of the visceral organs, — and the tegumentary system 

 together with their sympathetic relations, is it any wonder that 

 cases of idiopathic tetanus should arise out of these morbid 

 conditions, without the stimulus of an external injury, or that 

 traumatic tetanus should be so frequently the sequela of a 

 puncture in the foot ? 



Since the adoption of this practice I have never known a 

 case of tetanus to supervene upon an injury of this nature 

 when I have had charge of the treatment from the beginning. 

 Several cases of tetanus that have been placed under my 

 charge, in mules and horses, after the teta?iic spasms have set in, 

 and known to have had a recent wound in the foot — have come 

 out right, but I attribute this result to the process of cutting 

 down upon the wound, applying narcotic poultices and above 

 all to the free use of the dilator, rather than to any constitu- 

 tional measure of treatment. 



AN INVALUABLE ADJUNCTIVE MEASURE. 



If general facts accord with my own experience, punctured 

 wounds of the foot are the most frequent source of tetanus. 

 Before I practiced dilation of the foot I have known some 

 cases to terminate unfavorably under ordinary treatment, and 

 some to take a considerable period to get well — and an occa- 

 sional one eventuated in tetanus, from which I never knew one 

 to recover. 



