TETANUS. 



Icciire the patient from the approach of tetanus. But the 

 difficulty is here to eftimate the probability of the patient's 

 iiaving the difeafe, as nothing Ihort of the certainty of its 

 being'at hand, could well juftify the operation. 



As it is matter of experience that an early and highly 

 ■ rritable and painful condition of the wound has a tendency 

 to excite tetanus, as well as a Hate in which the difcharge is 

 of a peculiar unhealthy charafter, or is fupprelTed altogether, 

 cur immediate objefts' (hould be to allay as much as poffible 

 *he local irritation, and to re-eftabhlh a healthy fecretiou of 

 pus. Mechanical caufes of irritation fhould as much as 

 poflible be obviated, by early attention to remove fplinters 

 of bone, balls, or other foreign bodies, that may be lodged 

 in the wound. Poultices and foothing applications will 

 anfwer the double purpofe of quieting local inflammation, 

 and bringing on healthy fuppuration. The irritability of 

 the furface may fometimes be moil effeftually deftroyed by 

 lunar cauftic, after w^hich, an emollient poultice may be ap- 

 phed. An oppofite plan of treatment has been recom- 

 mended by Dr. Ru(h, namely, that of exciting confiderable 

 inflammation in the wounded part, by epithems of turpentine, 

 and other highly ilimulating applications ; which, though it 

 may in certain cafes have fucceedod in preventing tetanus, 

 does not appear to be generally applicable, and feems ac- 

 cordingly to have been abandoned. On the contrary, it 

 has of late been the univerfal praftice in the navy, to add 

 tinfture of opium to the drelTings apphed to wounds, with 

 a view of preventing tetanus. With the intention of re- 

 exciting fuppuration where there is no difcharge, M. Larrey 

 recommends the application of blillers as near as poffible to 

 the wound, and adduces inllanccs of fuccefs from this mode 

 of treatment. 



But the cure of tetanus, when once it has commenced, is 

 to be fought for more by the ufe of general, than of topical 

 remedies. The feat of the diforder has been transferred to 

 the brain and nervous fyftem, and our efforts niiift be directed 

 to allay their inordinate adlions. The plan from which 

 theory would lead us to expeft moft fuccefs, is that of 

 exciting fome new aftion in thefe organs, by which their 

 energies would be direfted into fome different channel, and 

 the exifting morbid aSion would be fufpended and fuper- 

 feded. The remedies which exert the moft powerful imme- 

 diate effefts in the nervous fyftem, are accordingly found 

 to be the moft efficacious in the cure of tetanus. Opium, 

 ■wine, and other highly diffufible ftimuli, digitahs and 

 other narcotics, the fudden aff^ufion of cold water, bleeding, 

 purging, impregnating the fyftem with mercury, the exhibi- 

 tion of arfenic, of oil of turpentine, of alkalies, and of 

 ipecacuanha, have refpeftively been reforted to, and with 

 very vainous, and in general but limited fuccefs. The fame 

 methods from which cures have been obtained in the milder 

 cafes, generally fail to make the leaft impreffion on the dif- 

 eafe in its feverer forms. We learn from the valuable report 

 of fir James Macgrigor, already alluded to, that there were 

 very few, out of feveral hundred cafes that occurred in the 

 Britifti armies during the late campaigns on the Peninfula, 

 where this difeafe had made any progrefs, in which it ter- 

 minated fuccefsfully, or in which remedies, however varied, 

 feemed to have any beneficial influence. 



Opium is the remedy on which reliance has moft gene- 

 rally been placed in combating this formidable difeafe ; and 

 there is no doubt that in mild cafes it is competent to its 

 complete folution. But for this purpofe, it is abfolutely 

 neceffai^ that its ufe be begun from the earlieft appearance 

 of the fymptoms ; that it be given in very large dofes ; and 

 that the dofes be repeated at fliort intervals : fo that the 

 fyftem be kept conftantly under the influence of the remedy. 



It is, indeed, aftonifliing how the fyftem, when pofl'efled by a 

 ftrong difpofition to fpafm, will refift the operation of this 

 and other remedies, which in its ordinary ftate woidd have 

 been more than fufficient to overpower and deftroy it. 

 Patients labouring under tetanus will bear with impunity 

 quantities of opium, that at any other time would have been 

 certainly fatal. Inftances are upon record of five, ten, and 

 even twenty grains, being taken every two or three hours 

 for many days, without its producing any extraordinary 

 narcotic effects upon the fenforium. It is always, however, 

 advifeable to begin with comparatrv-ely moderate dofes, 

 fuch as forty or fixty drops of tinfture of opium, which 

 may be repeated at intervals of three or four hours, and in- 

 creafed at each repetition, till fome fenfible effeft is pro- 

 duced on the fpafms. It feems requifite to augment the 

 dofe rapidly, as the difeafe prefles upon us every hour, and 

 no time is to be loft in refifting its advances, while there is 

 yet a chance of controuling its fury. The circumftance of 

 the clofing of the jaw, and the difliculty of deglutition, the 

 increafe of which may foon render it hardly poflible to in- 

 troduce medicines into the ftomach, is an additional motive 

 urging us to pu(h our remedies before thofe obftacles arife. 

 Glyfters are our only refource, when it is impoffible to 

 overcome the fpafm of the fauces. Opium has alfo been 

 applied externally and topically to the jaws ; and relief has 

 fometimes been obtained from an opiate plafter on the 

 maffeter mufcles, or behind the ears ; but thefe are com- 

 paratively very trifling in their efficacy, and applicable only 

 to the llighteft cafes, or to thofe in which convalefcents are 

 ftill affefted with a recurrence of one or two local fymptoms. 



It is of the greateft importance in all cafes of tetanus, and 

 more efpecially where opium is given, to excite a proper 

 aiflion of the bowels, fo as to allov/ of no ftagnation of their 

 contents. The teftimony of the army phyficians, as appears 

 from the report of fir James Macgrigor, is highly in favour 

 of a rigid perfeverance in the ufe of purgatives, given in 

 dofes to produce a full effeft daily. Dr. Forbes ftates, that 

 a folution of fulphate of magnefia, in infufion of fenna, was 

 found to anfwer better than any other purgative, and it was 

 daily given in a fufficient quantity to procure a copious 

 evacuation, which was always dark-coloured, and highly 

 offenfive : and to this prafticc he chiefly attributes, in one 

 fevere cale, the removal of the difeafe. The infrequency of 

 locked jaw in the Weft Indies, in t!ie pubhc fervice, of late 

 years, is chiefly afcribed by Dr. Dickfon, to the greater 

 freedom with which purgatives have been employed, par- 

 ticularly fince the publication of Dr. Hamilton's work on 

 the operation of this clafs of remedies ; an opinion which is 

 corroborated by the teftimony of various authors, as to the 

 ftate of obftinate coftivenefs which prevails in this difeafe, 

 and the offenfive nature of the contents of the inteftines. 



For the introduftion of the ftimulant and tonic plan of 

 treatment, we are chiefly indebted to Dr. Rufli, who was 

 led to adopt it from fome theoretical views he entertained 

 on the nature of tetanus, which he conceived to be effen- 

 tially a difeafe of debility. There can be no doubt that 

 in many cafes the exhibition of wine or fpirits has been 

 attended with very good eft'efts. Dr. Hoffack, in vol. iii. 

 of the American Medical Repofitory, relates feveral cafes 

 which were cured by large quantities of wine. 



A free allowance of wine and porter after gun-fliot wounds 

 has appeared alfo, according to the ftatement of Dr. M'Ar- 

 thur, to have contributed to the very fmall number of cafes 

 of tetanus which occurred under his care in the hofpital at 

 Barbadoes, during nearly fix years of the moft aftive period of 

 the war. Of the numerous cafes of gun-fltot wounds received 

 into the hofpital, and of operations perfermed, during the 



whole 



