TETANUS. 



whole of that period, only two inftances of tetanus occurred. 

 Bark has been given in conjuntlion with wine and opium ; 

 and the muriated tiutlure of iron has alfo been ufed with ap- 

 parent advantage. The luccefs of tlie tonic plan of treat- 

 ment refts alfo on the teftimonies of Dr. Wright of Jamaica, 

 Dr. Cochrane ot Nevis, and feveral other Well Indian prac- 

 titioners ; and alio on that of Dr. Currie of Liverpool. 



The prelencc of an inflammatory diatheiis, which occa- 

 fionally accompanies the fpafmodic Hate, prefents, iiowever, 

 a material obftacle to the employment of the above-mentioned 

 remedies. So much is this the cafe, that many phyficians 

 have recommended the free ufe of the lancet, particularly in 

 the early llages of tetanus. Dr. Dickfon ftates it as his 

 opinion, that in a full habit, where the wound is fwelled, 

 inflamed, and painful, venefeftion, with free purging, and fuch 

 other means as are calculated to allay the general and local 

 irritation, afford the faireft chance of averting the danger. 

 (See the yth volume of the Medico-ChirurgicalTranfaftions, 

 part 2.) In the 6th volume of the fame work, a cafe is 

 detailed by Mr. Earle, in which, though it terminated fatally, 

 bleeding was beneficial, and leflened the patient's fufferings ; 

 and in the fame volume, it is alfo mentioned with appro- 

 bation by the medical officers in the Peninfula. Dr. M'Ar- 

 thur confiders that he ufed blood-letting with evident relief 

 in one cafe, in the naval hofpital at Barbadoes ; that the 

 fpafms were ameliorated, the difeafe protradled, and the 

 morbid appearances after death were lefs marked in confe- 

 quence. M. Larrey alfo adduces fome examples where it 

 produced a good effeft. Mr. Guthrie gives three cafes which 

 occurred in the hofpitals of St. Andero, out of many which 

 were recorded, vi^here venefeftion was the principal remedy. 

 In tlie firft, in which tetanus from a wound in the hand was 

 advancing with rapidity, the patient was bled ad deliquium 

 feveral times with good effeft, calomel and diaphoretics being 

 given at the fame time, and he recovered. In the fecond 

 cafe, the patient was bled in the fame manner, with an evident 

 amendment of the fymptoms ; fo much fo, indeed, that he 

 fuffered but little from fpafm, and could open his mouth 

 very weE, when he was feized with diarrhoea, which, in the 

 debilitated fliate he was in, carried him off. In the third cafe, 

 of a man of a fanguine temperament, and fuffcring from acute 

 tetanus, venefeftion pufhed to the utmoft totally failed. 



Digitahs has been tried in the Peninfula in leveral cafes, 

 occafionally with good effeft, though it never appears to 

 have elTefted a cure. Ether, camphor, mufl^, and other anti- 

 fpafmodics, as likewife the alkalies, were alio tried, and found 

 equally unfuccefsful. Caftor is ftrongly recommended by 

 Aratxus, but is too feeble a remedy to have any decifive 

 influence in fo violent a diforder. 



The affufion of cold water has in general been attended 

 with great benefit. It is a praftice particularly recom- 

 mended by Dr. Wright, in the London Medical Obfervations, 

 and is fanftioned bythe concurring teftimonies of Dr. Cochrane, 

 in the Medical Comment ai-ies, and of Dr. Currie, in his Me- 

 dical Reports, &c. as well as by many other praftitioners. 

 A large pailful of cold water thould be thrown upon the 

 patient every two or three hours ; he is te be immediately 

 wiped dry, and laid in bed after each affufion, and an opiate 

 draught adminiflered. Some remiffion of the fpafms will in 

 this way be generally obtained ; and many inftances are upon 

 record, of complete cures being effefted by perfeverance in 

 this plan. Before the introduftion of this praftice, the warm 

 bath was very commonly employed ; the patient, after ufing 

 it, being placed in bed, without being dried, between two 

 blankets, with a view to bring out a fweat. It does not 

 appear, however, that this plan was attended with any ge- 

 peral or permanent advantage ; and is certainly inferior in 



efficacy to the cold affufion. The cold bath, fays fir James 

 Macgrigor, in acute tetanus, is worfe than ufelefs. The ufe 

 of a not bath impregnated with potafs, and a few ounces of 

 quick-lime, has been much recommended by Dr. Stulz of 

 Suabia in traumatic tetanus. See Medical and Phyfical 

 Journal, vol. iii. 



The powerful relaxing effefts of tobacco given in glyftcr 

 in cafes of hernia and enteritis, have fuggefted its employ- 

 ment in tetanus. Mr. Earle tried it in one very acute calo, 

 in wliich, although it afforded a temporary alleviation from 

 fpafm, fo much agitation was produced by it, that it was not 

 perfevered in. He is, however, induced to recommend the 

 trial of a fuppofitory made of the extraft of nicotiana, and 

 parted up into the reftum. But, according to the report of 

 fir James Macgrigor, tobacco g!yfl;ers, tried in the advanced 

 ftage of the difeafe, feemed to have no effeft. He repre- 

 fents, however, the tobacco fume as deferving of further 

 trial. A remarkable cafe is recorded by Dr. PhiUips, in the 

 6th volume of the Medico-Chirurgical Tranfaftions, in whicii 

 the jaw fuddenly fell, upon the exhibition of an eisema with 

 oil of turpentine. 



It itas been fuppofcd that mercury thrown quickly into 

 the fyftem, fo as to excite falivation, would prove highly 

 ferviceable in relieving the fpafms, and particularly thofe of 

 the mufcles of the jaw. Tiiis praftice was firll introduced 

 by the praftitioners in the Weft Indies, and in paiticular by 

 Drs. D. and A. Monro, and appears to have fucceeded in 

 many cafes. Dr. Rufii conceives that its falutary efleft is 

 connefted with its inducing in the fyftem a ftate of inflam- 

 matory diathefis incompatible with the fpafmodic aftion, 

 wliich it would therefore fuperfede. Whatever benefit, how- 

 ever, may have been experienced from this plan in mild cafes, 

 it completely fails in the more fevere of making any impref- 

 fion on the difeafe. Dr. Emery, Mr. Guthrie, and other 

 medical officers attached to our army in the Peninfula, after 

 the battle of Salamanca, tried inunftion of the whole body 

 three times a day, with ftrong mercurial ointment, in unli- 

 mited quantity, with no degree of fuccefs. Mr. Guthrie 

 reports, that after the battle of Touloufe, a fatal cafe occur- 

 red in a man ftrongly under the influence of mercury, which 

 he had ufed previous to the aftion for the cure of the itch. 

 The combination of calomel with ipecacuanha, which has 

 been much recommended, is equally inefficacious with the 

 other remedies, in the acute and fully formed difeafe. In 

 the mild tetanus, benefit has been derixed from calomel : and 

 its operation on the bowels is always ufeful, and fingiJarly 

 fo in the mild difeafe diftinguifhcd by the fpafms coming on 

 flowly, and continuing of the fame violence ; inftead of their 

 fudden acceflion, and their continuing with increafing vio- 

 lence, as happens in the acute fully formed tetanus. In this, 

 calomel cannot be depended upon, as the patient is carried 

 off before the medicine can have any effeft. 



Several remedies vs'ere formerly in vogue, of v\hich it is 

 hardly neceffary to give any account, as they have now loll 

 all the credit they once enjoyed. It may be fufficient to 

 mention the Barbadoes tar, alluded to by Dr. CuUen ; the 

 colchicum autumnale, or meadow faffron, recommended by 

 Dufrefnoy ; bliftering, eleftricity, unftuous applications, 

 partial fomentations, &c. moft of wliich appear either to 

 be inert, or at beft very weak auxiliaries to the remedies 

 already defcribed. 



Of late years, tetanus has been much lefs frequent in the 

 Weft Indies, when compared with former wars. This is 

 attributed, apparently with great reafon, by Dr. Dickfon, 

 to the improvements in the medical and furgical treatment 

 of wounds ; to greater cleanlinefs, and more perfedl venti- 

 lation ; and in general to fuperior comforts, diet, and acconi- 



3 F 2 modalion ; 



