GEN. I. SPEC. VI. & E. Tris mus nascen tium. Locked-jaw of infancy. B E. Tris mus cata rrhalis. Catarrhal this celebrated writer, it is more common to some districts than to others, has not been sufficiently determined. “It seems," says he, "to be more frequent in Switzerland than in France." Hot climates, however, constitute its principal domain; and hence it is not very surprising that Bajon should place one of its chief residences at Cayenne; or that Akerman should assert it to be endemic in Guinea. In the SECOND VARIETY of the disease, or that proceeding from cold or night dew, the symptoms often aplocked-jaw. pear within a day or two after exposure to the exciting It is not common that the spasm extends to the Description. Cause. muscles of the chest or back so as to produce tetanus, though there is often an uneasy sensation at the root of the tongue with some difficulty in swallowing liquids after their introduction into the mouth, the disease thus making an approach towards lyssa or canine madness in its symptoms, as we have just endeavoured to show that it does in its physiology. According to the observations of Baron Larrey, indeed, this approach is in many instances very considerable; for he informs us that on post-obituary examinations he has often found the pharynx and esophagus much contracted, and their internal membranes red, inflamed, and covered with a viscid reddish mucus. Dr. Hennen, however, does not place much dependence upon any such appearances; he admits, nevertheless, that they are to be traced occasionally, though he ascribes them more to an increased flow of blood consequent on increased action than to any other cause+. In this variety, from the slighter nature of its attack, the patient not unfrequently recovers by skilful medical treatment, and there are unquestionably instances of spontaneous recovery‡, though cases of this kind are very rare. The intellect remains unaffected, there is little 1781. Bajon, Abhandlung. von Krankheit. auf der Insel Cayenne, &c. Erp. + Principles of Military Surgery, 246. Briot, Hist. de la Chirurgie Militaire en France, &c. 8vo. Beganson, GEN. I. SPEC. VI. E. Trismus cata rrhalis. quickness of the pulse, sometimes none whatever, and little or no disorder of any kind, though the bowels are usually very costive. If the patient pass the fourth or fifth day we may begin to have hopes of him; for the Catarrhal spasmodic constriction will then frequently remit, or in- locked-jaw. termit: but, as even in the last case, it is apt to return Prognostics. at uncertain intervals, there is still a considerable danger for many days longer. appearance till mus trau locked-jaw. Symptoms appear later than in the preceding When, as in the THIRD VARIETY, the disease proceeds y E. Trisfrom a nerve irritated by a wound or sore of any kind, maticus. the spasmodic symptoms are much later in showing them- Traumatic selves; and sometimes do not make their eight or nine days afterwards, occasionally, indeed, not at all till the wound is healed. The disease is more dangerous in proportion to the delay; the adjoining muscles varieties: of the face become more affected, and, as is already ob- and are proserved, the spasms often shoot downward into the back portionally or chest, and trismus is complicated with tetanus. The gerous. breathing is nasal and abrupt, the accents are interrupted Description. and slow, and uttered by the same avenue; the muscles of the nose, lips, mouth, and the whole of the face are violently dragged and distorted, and the patient sinks from nervous exhaustion and want of nutriment, the jawbone being set so fast that it will often break rather than give way to mechanical force. more dan The disease, from this cause, is generally fatal: and This variety generally we are indebted to the ingenuousness of Sir James fatal. M'Grigor and Dr. Hennen for a confession that, whatever remedies were employed in the British army, whether in India or in Spain, the mortality was nearly the same. But as the treatment of the present variety and the ensu- Treatment ing species should be founded on a like principle, we shall reserve this subject till we have entered upon a distinct history of the latter. the same as for tetanus, and reserved for the close of that sub ject. SPECIES VII. ENTASIA TETANUS. Tetanus. PERMANENT AND RIGID FIXATION OF MANY OR ALL 66 TETANUS is derived from TiTaíve, which itself is a derivative from τείνω, tendo, extendo". Like trismus it is a term common to the early Greek writers, among whom it was used synonymously with opisthotonus and emprosthotonus, though the two latter were afterwards. employed to express two distinct modifications of the dis ease. From peculiarities in the seat or mode of its attack this species offers us the four following varieties: The FIRST of these VARIETIES is the emprosthotonus of early writers; the SECOND the opisthotonus; the THIRD the pleurosthotonus of authors of a later date; the FOURTH was GEN. I SPEC. VII. Entasia Tetanus. these. the proper tetanus of Dr. Lionel Clarke and a few others. To these varieties it has been usual to add the singular disease called catochus; which by Sauvages, Cullen, and va- Tetanus. rious other authorities is regarded as closely connected with Catochus this species. It has a near affinity to it unquestionably, how conand hence out of deference to concurrent opinions, it nected with suffered to stand as a variety of tetanus in the first edition of the author's Nosology, but with a note intimating that it seems rather to belong to the genus CARUS of the fourth order of the present class, and to be a modification of the species ECSTASIS, under that genus: and as this to be its proper place it will now be found arranged there accordingly. appears More prodivision of perly a sub carus. already The general physiology, so far as it seems capable of General elucidation, has been already given under the preceding physiology species; the proximate cause being that of a peculiar irri- glanced at. tation of a certain chain or association of nerves, chiefly Proximate operating with the greatest violence at the two extremi- cause. ties of the morbid line. This irritation seems, in many instances, to consist in inflammation; and hence is made a common cause by many of the most valuable writers of the present day. Professor Frank seems first to have started the idea, and he has been followed in succession by Dr. Saunders of Edinburgh, Dr. Chisholm, Dr. James Thomson, and Dr. Abercrombie, who have been upheld in Italy by M.M. Brera, Rachetti, and Bergamaschi, and in France by M. Esquirol. Bergamaschi* advances indeed so far as to maintain that where wounds themselves, of whatever form, are the remote cause, a neu- Neurostenia rostenia, as he calls it, or inflammatory affection of the of Berganerves, is still the proximate cause; extending itself from the wounded part, by the nervous extremities, to the spinal marrow and the brain, or, vice versâ, from the brain to the spinal marrow and principal nerves, and thence to the parts that are subservient to loco-motion. Dissection, however, is very far from giving proofs of such inflamma • Osservazioni Medico-pratiche sul Tetano.-Giornale di Medicina pratiea del Sig. Cons. e Prof. Cav. V. L. Brera. maschi. GEN. I. SPEC. VII. Entasia Tetanus. Tetanus. Exciting causes. Terror sometimes tory change in every instance: while in many cases the disease is of too fugitive a character, and makes its seizure or its disappearance too rapidly for the more measured progress of inflammation. The exciting causes are also for the most part those of TRISMUS; though it appears in infancy far less frequently, unless as a concomitant of that disease. Damp and cold, therefore, and simple nervous irritation from wounds or sores in hot climates and crowded hospitals, are the chief sources of its production; and where these accessories exist, terror seems to be a powerful auxiliary, and has alone, in some instances, been sufficient for its production. "Passion, or terror," says Dr. Hennen," after wounds and operations, has been known to produce the auxiliary to disease in some: and sympathy, though a rare cause, in others." It is said also to have been produced by insolation or exposure to the direct rays of the sun, and has unquestionably followed, as M. Magendie, and numerous other French authors have abundantly shown, from various irritant narcotics, as strychnine, or the extractive of nux vomica, as also from galvanism, when raised to a sufficient power for the purpose. them. Lateral tetanus peculiarly uncom mon, LATERAL TETANUS is very rarely to be met with, and seems to be rather a chronic than an acute malady. Fernelius, who first described it, gives a case in which it occurred annually, but only in the winter, during which season the patient had two or three paroxysms daily, the head was first attacked with a peculiar vibratory feeling which gradually descended to the neck with a sensation of cold, and by the time it reached the scapula, was immediately succeeded by symptoms of opisthotonus, and afterwards of lateral contraction; during which the mind and external senses were unaffected, but the flexor-muscles were so firmly fixed that no antagonist force of the bystanders was able to overpower the contortion. *Pathol. Lib. v. p. 372. + Desportes, Raffenean, Fonquier, Dupuy. |