TETANUS. 



warm day in March, and went to bed without a cap : but 

 the weather changing and becoming cold in the night, be 

 was I'eizcd with tetanus, and the next morning was found 

 rigid with the dileafe. The imprudent ufe of the cold 

 bath, or even a draught of cold water, when the body has 

 been warm by exercile, has frequently brought on tetanus. 



In temperate clnnates, on the other iiand, the dileafe 

 feldom arifes from the application of cold ; although there 

 is one well-attelted inftance mentioned by Dr. Gregory in 

 hisleftures.'of its occurring from tiiis caufe in Scotland: 

 but it is more frequently the confequence of lacerated or 

 puntlured wounds, and is particularly incident to injuries of 

 nerves, and of tendinous parts. It fometimes follows the 

 amputation of a limb ; and it would appear that wounds of 

 the joints, particulaj-ly thofe of the hands or feet, are 

 more peculiarly liable to produce tetanus. In warm 

 countries, the flightell cut or bruife is in danger of being 

 fucceeded by this formidable malady. Hence few of thole 

 that are wounded in battle recover : and few furvive any 

 conliderable operation. It has been fuppofed by many, that 

 tetanus arofe from the partial divifion of fome nervous fibres, 

 in confequence of which the undivided filaments were un- 

 equally and violently ilretched : a ftate which would be re- 

 medied by their complete divifion. Experience, however, 

 the ftubborn enemy tc5 fo many hypothefes, has by no means 

 proved favourable to this opinion. It has alfo been ftated 

 to be more frequently the refult of wounds, which remain 

 in a Hate of great irritability, without proceeding to fup- 

 puration ; it does not, however, appear that this pofition is 

 Supported on any extcnfive obfervation. It very often hap- 

 pens, indeed, that tetanus fliews itfelf when the wound was 

 almoft healed, and the dreffings have been laid afidc. 



In the late campaigns of our armies in the peninfula of 

 Spain and Portugal, according to the report of fir James 

 Macgrigor, tetanus occurred in every defcription, and in 

 ©very flage of wounds, from the flightell to the moll for- 

 midable, from the healthy and the iloughing, from the in- 

 •ciied and lacerated, from the moil fimple and moll compli- 

 cated. It occurred at uncertain periods ; but it was re- 

 marked, that if it did not commence before twenty-two 

 days from the date of the wound, the patient was fafe. It 

 terminated in the fecond, third, and fourth days, and even as 

 late as the feventeenth and twentieth days, though ufually it 

 was not protrafted beyond the eighth. The" moil rapidly 

 fatal cafe that has ever been recorded, is one that we have on 

 the authority of the late profeiTor Robifon of Edinburgh. 

 It occurred in a negro, who was a waiter at a tavern, and 

 who happened to fcratch his thumb with the broken edge of 

 a china plate, and who died of tetanus a quarter of an hour 

 after this apparently flight accident. 



As the acute form of traumatic tetanus, obferves Dr. 

 Dickfon, is fo uniformly fatal, it is of the greatelt confe- 

 quence to attend to whatever may aflift in detefting the dif- 

 ezie early, or in warding it off. Richerand ftates, that in 

 wounds threatening convuHions and tetanus, a perfevering 

 exteniion of the limbs during fleep often manifefts itfelf 

 before any affeftion of the lower jaw ; and we fliould natu- 

 rally pay more attention to any admonition of this kind in 

 punftured or extenfive lacerated wounds, particularly of 

 tendinous or ligamentous parts, efpecially in injuries of the 

 feet, hands, knee-joint, back, &c. in which the difeafe moll 

 frequently fupervenes. Some prelulive indications of dan- 

 ger may often be derived from the increafe of pain, irrita- 

 tion, and reilleffnefs, nervous twitchings, pain and difficulty 

 in deglutition, or in turning the head ; fpafms, or partial 

 rigidity of fome of the voluntary mufcles ; pain at the fcro- 

 biculus cordis ; a fuppreffed or vitiated ftate of the dif- 

 Vm.. XXXV, 



charge, &c. whicli mark the flower approaclics of the dif- 

 eafe. M. Larrey adduces fcveral inllanccs of tetanus, in 

 which the wound was either dry, or afforded only a fcaiity 

 ferous exudation, and where the fymptoms were relieved on 

 (uppuration being re-eilablilhed ; and Dr. Reid, in the 

 Edinburgh Medical and Surgical Journal for July 1815, re- 

 marks, that on removing the dreiTing, inttcad of healthy pus, 

 the furface af the wound was coverd with a dnrkilh unhealthy 

 looking matter, which he liad in two former inllanccs noticed 

 as the forerunner of tetanus. A torpor of the intellines has 

 generally been obferved to precede as well as to accompany 

 the difeafe. Mr. Abernethy obferves, that in four cafes 

 where he inquired into the Hate of the bowels, the evacua- 

 tions were not like fseces ; and he propofes as a quellion in 

 invelligating the canfe, what is the Hate of tiie bowels be- 

 tween the infliftion of the injury and the appearance of this 

 dreadful malady ? Dr. Parry has adduced the velocity of 

 the circulation as an uleful criterion of the danger of the 

 difeafe ; and obferves, that if the pulfe be not above looor 

 1 10, by the fourth or fifth day the patient almoll always re- 

 covers ; but if it be quickened early, that it proves fatal ; and 

 yet there are a few inllances of recovery where the pulfe has 

 rifen to 120 on tiie firil day. M. Larrey remarks, that 

 when the perfpiration, which fo often attends the difeafe, is 

 fymptomatic, it begins upon the head and extremities ; and 

 when it is critical, it occurs over the chell and abdomen : 

 but in many cafes, perfpiration flows very freely without 

 bringing relief. 



We have already ftated, that in fome inllances the fource 

 of irritation producing the difeafe is not obvious. Such 

 cafes of fpontaneous tetanus are very rare. Dr. Willan, in 

 his Reports, p. 289, mentions having met with an inllance in 

 a female, 32 years of age, where there had not been any 

 previous accident or local injury whatever ; and where tlie 

 only circumllance, which was likely to have contributed to 

 its production, was fevere dillrefs of mind, occurring in a 

 frame previoully debihtatcd. 



When we refleft upon the obfcurity which involves both 

 the ratio fymptomaliim and the proximate caufe of tetanic af- 

 feftions, we need not wonder that the praftice in thcfc 

 diforders fliould Hill be entirely empirical. Tiie indication 

 of cure which is generally applicable in all difeafes, namely, 

 the removal of the exciting caufes, has but little place in a 

 morbid condition, which is the confequence of caufes that in 

 general have ccafed to adl, or which it is not in our power 

 either to remove or controul. In thofe cafes where we 

 could fuppofe local irritation to be ftill operating, the moft 

 effeftual method of counterafting its effefts on the fyftem, 

 would obvioufly be to intercept all communication between 

 the feat of the irritation and the fenforium. It, however, 

 the difeafe has already eftabhftied itfelf, and the fevere 

 fymptoms have come on, it does not appear tiiat this would 

 fucceed in arrefting tiie courfe of the diiorder. Experience 

 has but too fully Ihewn, that the amputation of the limb 

 from the injury of wliich the tetanus had arifen, will very 

 feldom procure even a mitigation of the fymptoms, if p.r- 

 formed after a certain period from their firft appearance. 

 This plan was fully tried in our army at Touloufe, and 

 totally failed. In fome inftances, however, it is faid that a 

 favourable change has cnfued, and that patients have even 

 recovered by the facrifice of the wounded limb : and it has 

 been remarked, that the fpafms relaxed immediately on the 

 divifion of the foft parts by the knife, and before tlie faw 

 was applied to the bone, in order to complete the operation. 

 It is, therefore, highly probable, that the free divifion of the 

 parts above tlie wound, or ftill more certauily the ampu- 

 tation of the limb, would, at a certain ftage 'jf the affeftion, 

 3 F fecure 



