SPEC. VII. Entasia Tetanus. Tetanus. and hence at object of pursuit. How to be attempted. GEN. I. applications to allay the morbid sensibility; resinous, terebinthinate, or mercurial stimulants to excite a new action; and amputation of the diseased limb. The first of these three plans is the ordinary mode of practice, and in full plethoric habits it has sometimes proved favourable; the second plan seems to have been very generally employed by Baron Larrey, who occasionally used stimulants of a far higher power, as pencilling the wound with lunar caustic, or an application of the actual cautery. It is upon this principle of counter-irritation that advantage has sometimes been derived from needle-puncturing, of which the puncturing. periodical journals have lately furnished us with various examples*: and, by the French pathologists, from an emStrychnine. ployment of strychnine or the active alkaline part of nux vomica, where the disease has not been primarily induced Amputation by this irritant +. Amputation seems to have answered desperate in a few cases, if we may give full credit to those who remedy even have chiefly tried and recommended it‡; but it is at best Needle a clumsy and when suc cessful. Constitu tional treatment. Disease has been cured by intoxication. a clumsy and desperate kind of remedy; and, for reasons already assigned, must be often altogether inefficient if it do not add to the constitutional erethism. The general treatment has consisted in a free use of opium; salivation; the hot or cold bath; and wine or ardent spirits, in some instances so far as to produce intoxication. Dr. Cross gives a case in which, after other medicines had been used in vain, and every hope seemed to fail, the patient was inebriated with spirits, and kept in this state for ten days, with the result of a perfect reAn exciting covery §. A generous use of wine appears to be almost state of regimen almost indispensable, and, considering the ordinary constitution in which the disease occurs, the difficulty of supporting the system by common means, and the great sensorial exhaustion which is perpetually taking place, it is far from difficult to explain in what manner it operates beneficially: indispensable: * London Med. Repos. Vol xx. p. 403. Case furnished by Mr. Finch. †M. Coze. Remarques sur la Nux Vomique, &c. Silvester, Med. Obs. and Inquir. 1. Art. 1. White, Med. Obs. and Inq. n. Art. XXXIV. S Thomson's Annals of Philosophy. but intoxication is a frantic experiment, and, where it succeeds once, we have reason to apprehend it would kill in a hundred instances. GEN. I. SPEC. VII. Entasia Tetanus. Tetanus. Treatment. but intoxication a desperate experiment. Warm and The warm and the cold bath have each of them a much better claim to attention; and their votaries are so equally divided that it is no easy matter to say which is most strongly recommended. The latter demands more general strength in the system than the former: but neither of them are to be depended upon except as an auxi- cold bathing. liary. The cold bath has the authority of Dr. Lind in its favour*, and has in some instances been tried with success in America +. employed so as to excite Mercury, in various forms, has been had recourse to Mercury from a very early period: and, on the authority of Dr. Stoll, has occasionally been used for the purpose of ex- salivation. citing salivation. On what ground it has been carried to this extent I do not know, except it be that a pretty free flow of saliva from the mouth spontaneously has, by many persons, been regarded as a favourable sign. The disease, however, does not seem to be accompanied with any symptom that can be called critical; and it is hence probable that this spontaneous flow of saliva is nothing more than a result of the violent action and alternating relaxation of all the parts about the fauces. Nevertheless, salivation where it has been accomplished, is said by many writers to have been serviceable, though I know of no practitioner who has relied on it alone. And, in reality, such is the rapidity with which both trismus and tetanus usually march forward where they have once taken a hold on the system, that we have seldom time to avail ourselves of this mode of cure, were its pretensions still more decisive than they seem to be. It is most successfully employed after copious venesection, and in conjunction with opium. Opium, indeed, in every stage and every variety of both tetanus and locked-jaw, is the remedy on which we are to place our chief if not our only dependence. But to give * Essay on Diseases in Hot Climates, p. 257. + Tallman. Amer. Phil. Trans. 1. XXI. Cochran, Edin. Med. Com. Vol. 11. p. 183. Opium chiefly to be depended upon in every stage and modification : GEN. I. SPEC. VII. Entasia Tetanus. Tetanus. Treatment. to be given in very free doses. : it a full chance of success it should be administered in very free doses, and it is not easy for us to be too free in its use. In the Edinburgh Medical Commentaries* we have a case in which five hundred grains were taken within seventeen days, which is about thirty grains a-day and in the Edinburgh Journal+, another case, in Exemplified. which, after smaller doses along with calomel, the practitioner at last gave a drachm of solid opium at one time. This, however, proved too high a dose; for the induced stupor was accompanied with very laborious respiration, and nearly an extinction of the pulse, and the patient was obliged to be roused by stimulants. He recovered ultimately. Yet in the West Indies opium is often carried with the most beneficial effects to as great an extent as this, though not at once. Thus Dr. Gloster of St. John's, Antigua, gave to a negro, labouring under tetanus from an exposure to the night air, not less than twenty grains every three hours, in conjunction with musk, cinnabar, and other medicines: and continued it with but little abatement for a term of seventeen days, in the course of which the patient took five hundred grains of this narcotic. For the first six days little benefit seemed to be effected, but after this period the symptoms gradually declined under the same perseverance in the medicine; and in thirteen days more they were so much diminished that no further assistance was thought necessary. Opium in union with sudorifics: especially ipecacuan : as given by Latham. If there be any thing which adds to the sedative power of opium in this disease it is sudorifics, and particularly ipecacuan. And upon this subject Dr. Latham has given a valuable paper in the Medical Transactions, in which he offers examples of failure in the use of James's powder, when used either alone or in alternation with opium; but of full success by uniting the two powers of the narcotic and the sudorific, though he afterwards preferred ipecacuan to James's powder, and prescribed it in the form of the compound powder of this name. He gives cases in * Vol. 1. p. 88. + Edin. Med. and Surg. Journ. No. LXXI. Mr. Barr's case. GEN. I. SPEC. VII. Entasia Tetanus. Treatment. which he employed this compound in very severe attacks, and sometimes in what seemed to be its last stage of the disease, with an immediate arrest of its symptoms, and Tetanus. progressively a perfect restoration to health. His doses consisted of ten grains repeated every three or four hours. In no instance was there any unusual inclination to sleep, how long soever this treatment was continued, which in one case was for a forrtnight: nor was there any degree of sickness, nor any other inconvenience, except that of a perspiration troublesome from its excess*. : remove, Proper venessential importance. tilation of The bowels to be relieved of costiveness by gentle ape. It is only necessary to observe further that during the treatment either of trismus or tetanus, a very particular attention should be paid to ventilate the chamber with pure air and especially to purify the air of close and crowded hospitals, without which no plan of treatment in the world can be of any avail. We should also if possible, the costiveness to which the bowels are so peculiarly subject, by some gentle aperient: for it sometimes happens, not only in infantile trismus or tetanus, but in that from obstructed perspiration, or cold and dampness, that the primary cause of irritation is seated in the bowels: while, whatever accumulation takes place in this quarter, during the course of the disease, may add to and exacerbate the general erethism. At the same time no- but drastic thing can be more mischievous than the drastic purges highly miswhich practitioners are apt to give at the commencement chievous. of this disease, consisting of jalap, scammony, and aloes. We have have already seen that the general excitement Explained. is so extreme that the slightest occasional irritation, even that of changing the position of the head, is sometimes sufficient to produce a return of the spasms: and hence there can be nothing more likely to do it than the griping effects of such acrimonious medicines. And it will be far safer to pass by the constipation altogether, than to attempt to remove it by such dangerous means. The best medicine is castor oil, which may be given either by the mouth or in the form of injections: and if this do not * Med. Transact. Vol. iv. Art. iv. purges GEN. I. SPEC. VII. Entasia Tetanus. Tetanus. Treatment. succeed, we may employ calomel. But the action of the bowels must only be solicited, and by no means violently excited. GEN. I. SPEC. VIII. Antiquity SPASMODIC SPECIES VIII. ENTASIA LYSSA. Rabies. CONSTRICTION OF THE MUSCLES OF THE CHEST; SUPERVENING TO THE BITE OF A RABID ANIMAL; USUALLY PRECEDED BY A RETURN OF PAIN AND INFLAMMATION IN THE BITTEN PART: GREAT RESTLESSNESS, HORROR, AND HURRY OF MIND. THE Greek term for rabies was LYSSA: and the antiquity of the disease is sufficiently established from its being referred to several times under this name by Homer in his Iliad, who is perpetually making his Grecian heroes compare Hector to a mad-dog xúva xuσonτñρa, κίνα λυσσητῆρα, which is the term used by Teucer; while Ulysses, speakrepeatedly ing of him to Achilles, says, of the spe.cific name and of the disease itself. Noticed in the Iliad. Lyssa preferable to hydrophobia, its common synonym, and why. κρατερὴ δὲ ἑ ΛΥΣΣΑ δέδυκεν. * So with a furious LYSSA was he stung. The author has ventured to restore the Greek term, not only as being more classical, but as being far more correct than the technical term of the present day, which is hydrophobia, or water-dread; since this is by no means a pathognomic symptom; being sometimes found in other diseases; occasionally ceasing in the present towards the Hydropho- close of the career; and, though almost always observable among mankind, in numerous instances wanting, even symptom: from the commencement, in rabid dogs, wolves, and other being frequently absent in quadrupeds: bia not a constant * Iliad, 1x. 237. |