TETANUS AND ITS PROFITABLE DISCUSSION. 713 
aconite and sheepskin in other two cases ; one recovered, and 
the other (an aged horse) died on the fourteenth day, and 
twenty-four hours after a complete subsidence of all tetanic 
symptoms, from sheer exhaustion. I am compelled to confess, 
however, that w r ith me, as with most other practitioners, by 
far the greater majority of cases have been fatal. 
Again, as to whether traumatic or idiopathic tetanus is the 
least fatal and most easily managed ; and as to the distinc- 
tive characteristics of the latter Mr. Simpson seems to have 
adopted very isolated and erroneous ideas as to both these 
questions. The distinctive terms traumatie and idiopathic , 
although very convenient, are to my mind rather more super- 
fluous than necessary ; for, to produce such frightful nervous 
disorder as that presented in this disease, there must some- 
where be extensive lesion in the excito-motory nervous system, 
in which lies the root of the whole matter. But it is taken 
for granted that where the lesion is visible, such as bodily 
injury, the affection is traumatic ; where invisible, such as 
intestinal worms or the internal effects of (or lesions produced 
by) extreme heats or colds, it is idiopathic. As to idiopathic 
tetanus being induced by intestinal worms, see Erichsen’s 
‘ Science and Art of Surgery,’ 1857. In real traumatic 
tetanus the injured or diseased afferent nerve, in connection 
with the external lesion, conveys or transmits to or produces 
in the spinal cord some peculiar irritation constituting the 
disease ; and the spinal cord in its turn becomes the medium 
of conveying, by the efferent nerves, the disease to the mus- 
cular system, causing the usual spastic rigidity, &c. In idio- 
pathic tetanus we fail to discover any diseased or injured 
afferent nerve, the disease originating in the centre of the 
excito-motory system. In traumatic , therefore, we have not 
only to cope with the spasmodic state of the muscular system, 
but also with the injured, and, perhaps, what is worse, dis- 
eased afferent nerve. One cannot but see that it is the dis- 
eased state of the afferent nerve which is the great rock ahead 
in all severe cases of traumatic tetanus ; for, allowing the 
possibility of allaying the spasms in such a case, have we 
not still the exciting cause remaining, and carrying its 
usual peculiar irritation to the great centre of the disease, 
i. e . the spinal cord ? I am inclined to think that if it were 
possible, in every traumatic recovered case, to make a dissec- 
tion along the course of the afferent nerve which carried the 
irritation from the external lesion, we should find that the 
nerve had merely been injured , and never diseased. There 
is an immense difference between injury and disease in every 
tissue, but surely much more so in that fraught with so much 
