Tetanus. 351 



"He fell into deep water, swam ashore and made a recovery. But 

 -whatever virtue may be in elimination of the toxins by bleeding, 

 in nervous derivation or in the shocking of an unbalanced ner- 

 vous system, these can hardly be recommended as regular meth- 

 ods, of treatment. Yet the older veterinary records contain many 

 instances of alleged benefit from bleeding. 



Internal treatment. The whole list of antispasmodics have 

 l)een tried, with no very satisfactory result. Opium has been 

 •extensively employed in spite of its tendency to encrease consti- 

 pation, and morphia given hypodermically has checked spasm 

 a.nd induced sleep. Hydrocyanic acid and potassium cyanide 

 have shown a decided reducing action on the spasms with the 

 ■same drawback of favoring constipation. Potassium and other 

 bromides are useful in mild and chronic cases, and may be given 

 in full doses in combination with chloral hydrate. Calabar bean 

 and eserine have been given for their physiological action on the 

 nerve centres, and recoveries have followed their use, but they have 

 little effect on the spasms until the system has been saturated to 

 the point of threatening collapse. Chloroform has the advantage 

 that it can be easily- given by inhalation, but while it may be 

 pushed to the extent of temporarily checking the spasms, yet 

 these return at once when the action of the drug is exhausted. 

 "Chloroform is always dangerous to a weak or exhausted heart 

 .and cannot be given for any great length of time continuously. 

 It is, therefore, very Unsatisfactory. Sulphonal and trional have 

 ■similarly checked the spasms. Gelsemium has given good re- 

 isults in certain mild cases, but it must be pushed to the extent of 

 coming just short of poisonous doses, and the fear of an overdose, 

 together with its failure in severe cases, have prevented its gen- 

 eral acceptance. The same end has been sought by the use of 

 nauseating antispasmodic agents, as tartar emetic, tobacco, apo- 

 morphia, and lobelia, but, though useful in individual cases, 

 these are on the whole no more successful than other agents. 

 Phenacetin, antipyrin, acetanilid and cocaine have respectively 

 received credit for some recoveries. 



Chloral hydrate commends itself as being at once a most potent 

 ^antispasmodic and hypnotic, and an antiseptic. It can, moreover, 

 be conveniently given as a rectal injection, thus avoiding the irri- 

 gation and excitement of administration by the mouth. Given 



