Trismus, or Lockjaw.

By tetanus we understand sudden contractions 01 cramps, long-continued and violent twitching of the vo luntary muscles of various parts of the body. Generally the muscles most easily affected are those of the neck jaws, and throat. The patient feels an uneasiness in bending or turning the head, at length there is difficulty in opening the mouth, and this is shortly followed by closing of the jaws, either gradually, but with great firmness, or suddenly, and with a snap. Soon the muscles connected with swallowing become affected, and this is shortly followed by a severe acute pain in the lower part of the sternum, piercing through to the back. The pain is subject to aggravation in paroxysms, the spasms extending to the muscles of the trunk] to the large muscles of the extremities', the muscles of the face, and so on until all the voluntary muscles of the body may become fixed. As the disease advances, the spasms increase in frequency and violence, and are attended with intense pain. Where the contractions or spasms are confined to the lower jaw, the disease is generally called "trismus or lockjaw."

Causes

The most common causes are punctured and lacerated wounds, which injure one or more of the nerves. It is more liable to follow punctured wounds in the extremities than in the trunk. Taking cold in wounds, the irritating effects of splintered bones and foreign substance, such as, dirt, rust, etc, also blows upon the back may lead to tetanies. It sometimes, although much more rarely, follows suppressed menstruation, low fevers and violent exertion of the mind and body.

Treatment

The exciting cause should by ascertained and removed if possible.

Nux-V

This is a highly important remedy in almost every variety of tetanus. It is especially indicated where the spasms are frequent and short, and there are cramplike pains in the region of the stomach, constipation and loss of appetite. If the patient has been addicted to the use of spirituous liquors, the indications for the remedy will be still more apparent.

Dose

A powder, or six globules on the tongue every hour.

Arnica

This remedy may be used with advantage as an external application in those injuries which threaten to lead to tetanus. Six drops may be mixed with three tablespoonfuls of water, and the wound washed with the mixture three or four times a day. Two drops also may be mixed in a tumbler half full of water, and a table spoonful given at the same intervals.

Belladonna may be given where the disease affects principally the extremities, and where it is occasioned by deranged menstruation and difficulties connected with the utero-genital system; also where delirium is present.

Dose

Two drops, or twelve globules, in a tumbler of water, a tablespoonful every two, three, or four hours. Pulsatilla may be given with advantage after Belladonna, at the same intervals.

Should there be great rigidity of the extremities, wild and fixed look, and difficult respiration and deglution, Stramonium will be indicated in alternation with Ily-osciamus. Give every hour or two hours, prepared same as Belladonna.

Warm bathing and the external application of hot fomentations are often productive of decided relief. Among the other remedies which may be indicated, we may enumerate, Veratrum, Hydrocianic-acid, Phospho-rus, and Camphor.