PATH 
effeCl produced on the blood-veffels by the contractions 
of the mufcles, which will hurry on the circulations and 
throw the blood upon the heart in larger quantity than 
ufual, rendering the pulfe contracted, frequent, and ir¬ 
regular. The refpiration is hurried from the fame 
caufe, and the temperature of the body, as might be ex¬ 
pected, is increafed in the fame proportion. That thefe 
fymptoms are not the eft’eCt of fever, appears from the 
ftate of the blood, which is found to be of a loofer texture 
than natural, and never exhibits the buffy coat, as in 
inflammatory difeafes. On fome occafions, indeed, when 
the diforder is very violent, the arterial actions are in¬ 
creafed, and a febrile ftate prevails ; and this appears to 
take place more frequently when the difeafe has origi¬ 
nated 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 fweat. The tongue is 
always moift. Vomiting fometimes takes" place early in 
the complaint, but it commonly fubfides 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 be got down appears to be fufficiently well digefted. 
Some local effeCls feem to be attributable to the con¬ 
tractions of the abdominal mufcles. The fphinCter of 
the bladder is occafionally affeCted 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-co¬ 
loured, and fomewhat turbid. The bowels are found to 
be, in every in fiance, obftinately coftive, a ftate which 
may partly be accounted for by the effeCt of opiates, 
which are fo generally adminiftered for the cure; but 
which, independently of this caufe, appears to be inhe¬ 
rent in the difeafe itfelf. The bowels require the mod 
draftic purgatives; and there is a great fenfe of uneafinefs 
about the precordia. In the latter ftages of this dif¬ 
order, indeed, when the powers of life begin to decline 
from the vaft expenditure of energy occafioned by the 
violent mufcular aClions, every function in the fyftem 
partakes of the general diforder; the intellect gives way, 
and the patient finks from exhauftion alone, if a general 
convulfion does not occur to haften his end. It is men¬ 
tioned by Dr. Cullen, that, in feveral cafes, a miliary 
■eruption has appeared upon the fisin, but he expreffes a 
doubt whether this was a fymptom of the difeafe, or the 
effeCt of a certain treatment of it. It has not been ob¬ 
ferved, he adds, to denote either fafety or danger, or to 
have any effeCt in changing the courfe of the diftemper. 
Tetanus arifing from wounds is in general flower in 
its progrefe than that which proceeds from cold : but is 
attended with more danger to life. It is often eight or 
ten days, and fometimes much longer, after the inflic¬ 
tion of a wound, before the firft fymptoms of tetanus 
make their appearance: and this frequently happens 
when the effeCls of the injury on the part itfelf appear 
tojiave fubfided ; when the wound has healed, and no 
pain or uneafinefs has remained. 
Sometimes the difeafe is very fudden in its acceflion, 
when it is alfo more fevere. Generally, however,' it 
.makes its attack in the gradual manner before defcribed. 
The moft rapidly fatal cafe that has ever been recorded, 
is one that we have on the authority of the late profeffor 
.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 
d ied of tetanus a quarter of an hour after this apparently 
flight accident. 
In the late campaigns of our armies in the peninfuia 
of Spain and Portugal, according to the report of fir 
Janies Macgrigor, tetanus occurred in every defcription, 
and in every ftage of wounds, from the flighteft to the 
moft formidable, from the healthy and the Houghing, 
front the incifed and lacerated, from the moft fimple and 
moft complicated. It occurred at uncertain periods ; 
but it was remarked, that, if it did not commence before 
4 
O L O G Y. 305 
twenty-two days from the date of the wound, the patient 
was fafe. 
As to the appearance of afore which gives rife to teta¬ 
nus, this is by no means peculiar. Some have ftated that 
the fore is generally in an irritable and morbid ftate, and 
by no means difpofed to fuppuratiom M. Farrey ftates 
that the wound is generally dry, or affords only a Icanty 
ferous exudation. Certain it is, however, that tetanus, 
as before noticed, is no uncommon attendant on wounds 
completely healed. 
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 unequally and 
violently ftretched : a ftate which would be remedied by 
their complete divifion. Experience, however, the ftuIn¬ 
born enemy to fo many hypothefes, has by no means 
proved favourable to this opinion. From the more vio¬ 
lent forms of the difeafe hardly any inftance of recovery 
has been known to take place. On the other hand, the 
mere protraCtion of the fymptoms is an indication of the 
comparative mildnefs of the difeafe. Indeed it is a re¬ 
mark as old as Hippocrates, that, if a patient furvives 
the fourth day without fuffering an exacerbation of his 
complaint, he is fafe. Dr. Parry has adduced the velo¬ 
city of the circulation as an ufeful criterion of the dan¬ 
ger of the difeafe ; and obferves, that, if the pulfe be not 
above 100 or iio by the fourth or fifth day, the patient 
al moft always recovers; but, if it be quickened early, that 
it proves fatal; and yet there are a few inftances of reco¬ 
very where the pulfe has rifen to 120 on the firft day. 
We muft remark however, that, in upwards of twenty 
cafes of this difeafe which Dr. Morrifon witneffed among 
negroes, the pulfe was in no inftance accelerated in the 
manner related by Dr. Parry. This author never knew 
it above 98, whether the termination was favourable or 
fatal. The following prognoftic paffage we (hall tranfcribe. 
“When the difeafe comes on gradually; when for the 
firft three or four days the mufcles of the jaws~are folely 
affeCted, and that perhaps not in any alarming degree; 
when the abdomen is not preternaturally hard, or the 
bowels obftinately coftive; when the fkin is moift and 
moderately warm, and above all when the patient enjoys 
fleep; we may (by the means hereafter to be fpoken of) 
entertain ftrong hopes of an eventual recovery. An in¬ 
creafed flow of faliva, where mercury has or has not been 
ufed, is always to be regarded as favourable; the lefs the 
general air of the countenance is changed, the better. 
On the other hand, when the attack is violent and Rid¬ 
den ; when the mufcles of the neck, back, and abdomen, 
are rigidly contracted; when the patient complains of a 
fhooting pain from the fternum towards the fpine ; when 
the belly feels hard like a board, and the leaft preffure 
thereon produces fpafmodic twitchings or contractions of 
the mufcles of the neck, jaws, &c. or when the fame ef¬ 
fect is brought about by the prefentation of any fubftance 
(folid or fluid) near the mouth, we have much reafon to 
fear a fatal termination. Spafmodic ftartings of the muf¬ 
cles fet in fometimes early in the difeafe, and, recurring 
every eight or ten minutes, are to be regarded as very 
unfavourable.” 
The only difeafe which tetanus can be confounded 
with, is rabies contagiofa. In the latter, however, there 
is generally fever; frequently increafed heat of the body. 
In rabies, vomiting is common at the commencement; 
not fo in tetanus. The delirium, too, of hydrophobia, 
is abfent in tetanus. The (hooting pain from the fter¬ 
num to the fpine is feldom wanting in tetanus or prelent 
in the other. 
Few patients fall a facrifice after the ninth or tenth 
days, which period they never could have attained, un- 
refs the violence of the complaint had in a great meaftire 
fubfided. In this milder form, however, it may be pro¬ 
longed.feveral weeks; and fometimes the fpafmodic dif- 
pofition remains even for months, before health is com¬ 
pletely. reftored. The pulfe, in. thefe cafes, continues 
flow. 
