306 P A T H O 
flow and hard, and the belly bound: but, if blood be 
drawn, it does not exhibit any difference from its ufual 
irate. Under every circumftance of recovery, indeed, 
the convalefcent labours long under general debility, and 
cannot, for months, raife liimfelf from a fupine or recum¬ 
bent pofture without affiflance, nor without pain. 
Occaiional deviations from the courfe above defcribed 
are met with in different cafes. The moll lingular of 
thefe anomalies is the one recorded by fir Gilbert Blane, 
in which tetanus prevailed to a very confiderable extent, 
without affed'ting the patient with the lead degree of 
pain. The fpafms were, in this inftance, accompanied 
with a tingling fenfation, which was even rather agreea¬ 
ble than diftreffmg. The cafe, however, terminated fa¬ 
tally j but, to the laff, no pain was experienced. In two 
cafes mentioned by the fame author, the fpafms affe&ed 
only the fide of the body in which the wound was fituated. 
The refult of diffeCtions of patients who have died of 
tetanus throws little light on the nature of this terrible 
affeCHon. Sometimes there are found flight effufions 
within the cranium ; but, in general, no morbid appear¬ 
ance whatever can be detected in the head. There ap¬ 
pears to be always more or lefs of an inflammatory ap¬ 
pearance in the villous coat about the cefophagus and 
ftomach in the neighbourhood of the cardia. Befides 
the rednefsand increafed vafcularity of thefe parts, M. 
Larrey dates that he found the pharynx and cefophagus 
much contracted, and covered with a vifcid reddifh mu¬ 
cus. Dr. M‘Arthur found, in feveral cafes, the intef- 
tines much inflamed; and in two of them a yellow waxy 
fluid, of a peculiar offenfive fmell, covering their inter¬ 
nal fnrface : but whether the inflammation was primary, 
or only a confequence of the preffure of the abdominal 
mufcles, which contract fo violently in this difeafe, he is 
unable to decide. More recent difledtions have difplayed 
inflammation and its confequencesin the fpinal marrow; 
but the cafes hitherto publiflied are too few in number 
to allow us to draw general conqlufions from them. 
The obfcurity which involves both the ratiofymptoma- 
tuin and the proximate caufe of tetanic affections, has oc¬ 
casioned the practice in thefe diforders to-be moflly empi¬ 
rical. The indication of cure which is generally appli¬ 
cable 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 ceafed 
toaCt, or which it is notin our power either to remove 
or control. In tbofe cafes where we could fuppofe local 
irritation to be dill operating, the mod effectual method 
of counteracting its effeCts on the fyflem, would obvi- 
oufly be to intercept all communication between the feat 
of the irritation and the fenforium. If, however, the 
difeafe has already eftablifhed itfelf, and thefevere fymp- 
toras have come on, it does not appear that this would 
fucceed in arreding the courfe of the diforder. Experi¬ 
ence has but too fully fliown, that amputation of the 
limb from the injury of which the tetanus had arifen, 
will very feldom procure even a mitigation of the fymp- 
toms, if performed after a certain period from their firfl 
appearance. This plan was fully tried in our army at 
Tculoufe, and totally failed. In fome indances, how¬ 
ever, it is faid that a favourable change has enfued, and 
that patients have even recovered by the facrifice of the 
-wounded limb : and it has been remarked, that the 
ipalins relaxed immediately on the divifion of the foft 
parts by the knife, and before the faw was applied to the 
bone, in order to complete the operation. It is, there¬ 
fore, highly probable, that the free divifion of the parts 
above the zcound, or dill more certainly the amputation of 
the limb, would, at a certain flage of the afl'eCtion, fecure 
the patient from the approach of tetanus. But the diffi¬ 
culty is here to eflimate the probability of the patient’s 
having the difeafe, as nothing fliort of the certainty of 
its being at hand could well juflify the operation. 
. As it is matter of experience, that an early and highly 
irritable and painful condition of -the wound has a ten- 
L O G Y, 
dency to excite tetanus, as well as a date in which the 
difcharge is of a peculiar unhealthy character, or is fup- 
preffed altogether, our immediate objeCt fliould be to al¬ 
lay as much as poffible the local irritation, and to re-efla- 
blifii a healthy fecretion of pus. Mechanical caufes of 
irritation fliould as much as poffible be obviated, by early 
attention to remove fplinters of bone, balls, or other fo¬ 
reign bodies that may be lodged in the wound. Poul¬ 
tices 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 mod effectually deflroyed by lunar caudic ; 
after which, an emollient poultice may be applied. An 
oppoflte plan of treatment has been recommended by Dr. 
Rufh ; namely, that of exciting confiderable inflammation 
in the wounded part, by epithems of turpentine, and 
other highly-dimulating applications; which, though it 
may in certain cafes have fucceeded in preventing teta¬ 
nus, does not appear to be generally applicable, and feems 
accordingly to have been abandoned. On the contrary,' 
it has of late been the univerfal practice in the navy, to 
add tinfture of opium to the dreffings applied 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 bliders as near 
as poffible to the wound, and adduces indances of fuc- 
cefs 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 to¬ 
pical remedies. The feat of the diforder has been trans¬ 
ferred to the cranial and fpinal nervous fyflem, and our 
efforts mud be directed to allay their inordinate aCtion. 
Bleeding has received the fulled trials in tetanus. Occa- 
fionally this has cured the difeafe; occafionally it has 
mitigated the fufferings of the patient, and fmoothed the 
way towards death ; and fo perfectly innoxious does it 
feem in all cafes, that it may be fearlefsly tried in all. 
A cafe has been related in which the application 
of leeches to the fpine was attended with a good effeCt. 
It is given, however, on the authority of one who con¬ 
ceived that fpinal inflammation and tetanus were the 
fame. 
The affufion of cold water has in general been attended 
with great benefit. It is a praCtice particularly recom¬ 
mended by Dr. Wright, in the London Medical Obferva- 
tions, and is functioned by the concurring teftimonies of 
Dr. Cochrane in the Medical Commentaries, and of Dr. 
Currie in his Medical Reports, as well as by many other 
practitioners. A large pailful of cold water fliould be 
thrown upon the patient every two or three hours; he is 
to be immediately wiped dry, and laid in bed after each 
affufion, and an opiate draught adminiflered. Some re- 
miffion of the fpafms will in this way be generally ob¬ 
tained; and many inflances are upon record, of complete 
cures being effected by perfeverance in this plan. Be¬ 
fore the introduction of this praCtice, the warm bath \6as 
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 
general or permanent advantage; and is certainly infe¬ 
rior in efficacy to the cold affufion. 
But neither bleeding nor cold affufion offers fo much 
to depend on in the cure of tetanus as aftive purging. 
The difordered date of the alvine difcharges in this dif¬ 
eafe firff led Mr. Abernethy to adopt the praftipe of pur¬ 
ging for its cure ; and of late the mod unequivocal tef- 
timonials of its efficacy have arifen from all quarters. 
Mr. Abernethy afked what was the date of the bowels 
between the infliCfion of external injury and the coming 
on of tetanus ? and the anfwer to this is pretty well 
known, the bowels are generally in a codive or otherwife 
morbid condition. And fince this faCt has been known, 
the proportion of tetanic cafes from wounds has been 
much lefs than formerly. Under thefe circumflances, it 
is 
