TETANUS. 



general, and this merely in confequence, as it would appear, 

 of till- mechanical efleit produced on the hlood-veirels by the 

 contraAiuns of the mufclcs, which will hurry on the cii-cu- 

 lation, and tlirow the blood upon the heart in larger quantity 

 than ufual, rendering the pulfe conUatled, frequent, and 

 irregular. Tiie refpiration is hurried from the fame caufe, 

 and the temperature of the body, as might be expedled, is 

 increafed in the fame proportion. That thefe fyraptomsare 

 not the efl'ect of fever, appears from the Rate of the blood, 

 wliich is ilatcd to be of a loofer texture than natural, and never 

 exhibits the buffy coat, as in inflammatory difeafes. Tiiis 

 circumftance is particularly noticed by Dr. Clephane, and alfo 

 by Dr. Chalmers ; and the remark has often been verified by 

 fubfequent obfervers. On fome occafions, indeed, when the 

 diforder is very violent, the arterial actions are increafed, and 

 a febrile (late prevails ; and this appears to take place more 

 frequently when the difeafe has originated from cold, than 

 when it has been excited by wounds. The flcin is at firft 

 natural, but, as the difeafe advances, is covered with a cold 

 Iwcat. The tongue is always moiil. Vomiting fometimes 

 takes place early in the complaint, but it commonly fubfidts 

 in the progrefs of it : it is even ufual for the appetite of 

 hunger to remain through the whole courfe of the difeafe ; 

 and what food can bo got down appears to be fufficiently 

 well digefted. Some local efTefts feem to be attributable to 

 the contraftions of the abdominal mufcles. The fphinfter 

 of the bladder is occafionally affefted with fpafm, fo as to 

 impede the difcharge of urine, which is voided with pain 

 and difficulty : at other times, its fecretion is fuppreffed. 

 When It can be obferved, it is ftated as being high-coloured, 

 and fomewhat turbid. The bowels are found to be, in 

 every inftance, oblHnately coftive, a ftate which may partly 

 be accounted for by the efFeft of opiates, which are fo gene- 

 rally adminiftered for the cure : but which, independently of 

 this caufe, appears to be inherent in the difeafe itfelf. The 

 bowels require the moft draftic purgatives ; and there is a 

 great fenfe of uneafmefa abaut the precordia. In the latter 

 ftages of this diforder, indeed, when the powers of life begin 

 to decline from the vail expenditure of energy occafioned by 

 the violent mufcular anions, every funttion in the fyftem 

 partakes of the general diforder ; the intelledl gives way, and 

 the patient finks from exhauflion alone, if a general convul- 

 fion does not occur to haften his end. It is mentioned by 

 Dr. Cullen, that, in feveral cafes, a miliary eruption has ap- 

 peared upon the (kin ; but heexpreffes a doubt whether tliis 

 was a fymptom of the difeafe, or the effeft of a certain treat- 

 ment of it. It has not been obferved, he adds, to denote 

 either fafety or danger, or to have any effeft in changing 

 the courfe of the didemper. 



From the more violent forms of the difeafe, hardly any 

 inftance of recovery has been known to take place. On the 

 other hand, the mere protraftion of the fymptoms is an 

 indication of the comparative mildnefs of the difeafe. Few 

 patients fall a facrifice after the ninth or tenth days, which 

 period they never could have attained, unlefs the violence of 

 the complaint had in a great meafure fubfided. In this 

 milder form, however, it may be prolonged feveral weeks ; 

 and fometimes the fpafmodic difpofition remains, even for 

 months, before health is completely reftored. The pulfe, in 

 thefe cales, continues (low and hard, and the belly bound : 

 but if blood b drawn, it does not exhibit any difference 

 from its ufual Hate. Under every circumflance of recovery, 

 indeed, the convalefcent labours long under general debihty, 

 and cannot, for months, raife himfclf from a fupine or re- 

 cumbent pofture without afliflance, nor without pain. 



Occafional deviations from the courfe above defcribed are 

 met with in different cafes ; but they are not of fufficient 



importance to lay tlie foundation of any diilin^ft variety. The 

 moft fingular of thefe anomalies is the one recorded by Dr, 

 (now fir Gilbert) Blane, of acafe in which tetanus prevailed to 

 a very confiderable extent, without affedling the patient with 

 the lead degree of pain. The fpafms were, in this inftance, 

 accompanied witli a tingling feufation, which was even rather 

 agreeable than diftreftiiig. The cafe, however, terminated 

 fatally : but to the laft, no pain was experienced. In two 

 cafes mentioned by the fame author, the fpafms affefted only 

 the fide of the body in which the wound was lituated. 



The refult of dilTeSions of patients who have died of 

 tetanus, has thrown no light whatever on the nature of tliis 

 tei-rible afTeftion. Sometimes there are found (light effufions 

 within the cranium : but, in general, no morbid appearance 

 whatever can be detefted in the head. There appears to be 

 always more or lefs of an inflammatory appearance in ihe 

 villous coat about the cefophagus and ftomach in the neigh- 

 bourhood of the cardia. But thofe wIk) are converfant with 

 diife&ions, muft be well aware that thefe appearances are 

 common to a gfeat number of difeafes, and are uniformly 

 met with in every cafe of rapid or violent death. Befides 

 the rednefs and increafed vafcularity of thefe parts, M. Lar- 

 rcy ftates that he found the pharynx and cefophagus much 

 coiitrafted, and covered with a vifcid reddifh mucus. Dr. 

 M'Arthur found, in feveral cafes, the inteftines much in- 

 flamed ; and in two of them a yellow waxy fluid, of a pe- 

 ciJiar ofFenfive fmell, covering their internal furface : but 

 whether the inflammation was primary, or only a confe- 

 quence of the prefTure of the abdominal mufcles, which 

 contraft fo violently in this difeafe, he is unable to decide. 

 See Medico-Cliirurgical Tranfa£lions, vol. vii. p. 47 j. 



Tetanus is a difeafe much more prevalent in hot than in 

 cold climates. It is compai-atively a rare difeafe in this 

 illand ; but even here, the effect of warmth in giving a pre- 

 difpofition to it is fuflRciently obfervable. It is more com- 

 mon in the fouth than in the north of England, and is much 

 more feldom met with in Scotland than m England. It is 

 fenfibly more frequent in warm than in cold feafons. In 

 warm, and efpecially in tropical climates, it may be regarded 

 as an endemic difeafe, appearing at all feafons, but efpe- 

 cially during the prevalence of the greateft heats. Warmth 

 operates by increafing the mobility oi the fyftem, while at 

 the fame time it tends to diminifh the pofitive ftrength of the 

 fibre. The fenfibiUty to all inipreffions is greater in hot cli- 

 mates, wlule the power of refilling the caufcs of injury is 

 IclTened : hence the greater predifpofition to fpafmodic dif- 

 eafes in general. The natives of hot climates do not enjoy 

 a greater exemption from tetanus than European fettlers. 

 Negro (laves arc peculiarly liable to its attacks. It affedts 

 all ages, fexes, conftitutions, and complexions : but, caterh 

 paribus, is more apt to feize upon thofe in whom the largeil 

 (hare of vital power has been bellowed upon the mufcles of 

 voluntary motion. Hence it attacks more readily the 10- 

 buft, and thofe who are accuflomed to much bodily labour. 

 P.-.rtly on this account, and partly from their being more ex- 

 pofed to the occafional caufes of the difeafe, men are much 

 more frequently the fubjefts of tetanus than women. 



In the torrid zone, the moft frequent exciting caufe of te- 

 tanus is the application of cold when the body is heated. It 

 is often induced by the alternate cxpofure to the fcorching 

 heat of the fun, and to the heavy (bowers which frequently 

 occur in tropical regions, and produce great and fudden vi- 

 ciflitudes of temperature. Sleeping out of doors after a 

 hot day, efpecially on damp ground, or in a fituation where 

 a ftream of cool air is admitted to the body, is often follow. 

 ed by tetanus in hot chmates. Dr. Chalmers relates that 3 

 young man chofe to cut off his hair and ftiave his head on a 



warrrj 



