Tetanus, a spasmodic disease characterized by painful, involuntary, and protracted contraction of a greater or smaller number of the voluntary muscles. As seen in temperate climates, the disease is almost invariably consequent upon a wound or injury; but in particular localities and in hot climates, it may occur without any lesion either external or internal. The disease usually begins with chills and a feeling of depression and debility, with vertigo and sleeplessness. At first there is commonly a feeling of stiffness and uneasiness about the muscles of the neck and jaws. The patient thinks he has taken cold or has a slight rheumatic affection. He finds he is unable to separate the jaws to any distance, and more or less gradually they close, so that he is unable to open the mouth at all; a condition called locked jaw. As the disease advances there is acute pain at the bottom of the stomach, extending through toward the back; and this pain, like the contractions of the voluntary muscles, is aggravated in paroxysms. Gradually the large muscles of the trunk and extremities become affected. In some cases all the muscles are firmly contracted, and the body remains stiff and straight.
Ordinarily the strong extensors of the trunk and limbs are more affected than the flexor muscles, or their superior power overcomes the resistance of these latter, and during the paroxysm the body is forcibly curved backward, the patient resting upon his hands and heels only. This constitutes opisthotonos. Occasionally, though it must be very rarely, the body is bent forward, constituting emprostlwtonos; and still more rarely there is lateral curvature, forming pleu-rosthotonos. The muscles concerned in deglutition are early affected, so that swallowing is rendered difficult or impossible. Later, spasms of the muscles of the face occur, the brow be-, coming knit, the eyes wide open, fixed and staring, the nostrils distended, and the angles of the mouth drawn back, exposing the clenched teeth, and producing an expression called risus sardonicus. When the disease has once set in, the muscles affected are rarely at any time afterward wholly relaxed. At intervals more or less closely approximated to each other according to the severity of the disease, paroxysms occur during which the spasm is aggravated, the muscles affected becoming tense and hard aa boards.
During these paroxysms the patient commonly suffers from intense pain in the muscles affected, and the substernal pain, dependent probably on spasm of the diaphragm, is likewise aggravated. Cases have occurred in which the teeth have been broken, bones fractured, or muscles torn across. The spasms come on even when the patient is perfectly at rest; but they are evidently excited by the slightest attempt at voluntary motion, by efforts at deglutition, or by mental emotion. The patient's mind is commonly unaffected throughout the disease; the bowels arc apt to be obstinately constipated, and when evacuations are obtained they are offensive and unnatural. Death may occur either suddenly during a paroxysm or from suffocation, the muscles of respiration becoming fixed and the spasm in some instances probably affecting the glottis. In other cases death results from exhaustion, the patient being worn out by pain, sleeplessness, and want of nourishment. - Tetanus is fatal in the large majority of cases. Post-mortem examination throws but little light on its pathology.
Dr. Lockhart Clark believes that degeneration of the cells of the spinal cord is always present; but the fact that the symptoms are so similar to those of poisoning by strychnia would lead to the opinion that the cause of the disease is in a morbid condition of the blood, although the medulla oblongata and spinal cord are the parts attacked. In cases arising from wounds, the nerve leading from the wound shows evidences of inflammation, being commonly red and swollen; but with this exception no lesions have been found which arc constantly connected with the disease. - Idiopathic tetanus, rare in temperate, is not uncommon in hot climates; but though heat acts as a predisposing cause, the exciting cause is generally exposure to damp and cold. In traumatic tetanus, exposure to cold, particu-lariy when the body is debilitated by previo warm weather seen to be an efficient cans Thus the wounded in the battle of Dresden, who were exposed to cold and wet just after the battle, while the previous weather had been hot and oppressive,suffered severely from nus : and after the battle of Bautzen, where the wounded lay on the field exposed to cold and rain during the night, Larrey found more than 100 attacked with tetanus the next morning.
Tetanus is more liable to follow punctured and lacerated than incised wound.-: and wounds of the palmar - ice of the feet and hands, which are abundantly supplied with nerves, are particularly dangerous, but it may follow wounds of every character. Even those made by the knife of the surgeon and the stroke of a whip, the cutting of a corn and extraction of a tooth, have all been followed by this for-midable and fatal disease. Cases are on record in which lying-in women have been seized by the disease. The time which elapses between the reception of the injury and the period of invasion of the disease varies greatly. Larrey says that during the campaign in Egypt it rarely appeared before the fifth or after the fifteenth day; yet some cases are on record in which it came on in a few hours, and others in which it was delayed for more than a month. When the parox; - come on suddenly, recur at short intervals, and increase in violence, treatment is rarely of any avail: death in such cases occurs often as early as the second. and is : delayed beyond the fifth day.
When the at-tack is less violent and the interval between the paroxysms longer, the prospects of the patient are better, and if life is protracted beyond the tenth day he will frequently recover. - The treatment of tetanus is unsatis-factory. The inhalation of chloroform: has been strongly recommended, and where it well borne, it mitigates greatly the sufferings of the patient. Opium has been given in la: and repeated doses; when recourse is had to it, it should be administered in a liquid form, or some salt of morphia should be used. A strong solution of the sulphate of morphia may be given by subcutaneous injection. Wine and distilled spirits, with or without opium, have been given in larse quantities, and in many cases apparently with benefit. The bowels -should be occasionallv moved by active pur-gatives. But as the paroxysms are mainly excited by external sources of irritation, even slight ones, the principle of the treatment should be to keep the patient perfectly quiet. Stillness, a darkened apartment, few attendants, and the absence as far as possible of all causes of physical or mental disturbance, promise a better chance of recovery than any in a public disputation at the university of Frankfort-on-the-Oder, defended several antitheses.
The students of Wittenberg, in their turn, burned 800 copies of the antitheses of Tetzel. Tetzel replied once more, in May, by a refutation of the sermon of Luther on indulgences and grace, but seems to have had no longer any influence on public opinion. Among the latest biographers of Tetzel are Hoffmann, a Protestant (Lebensbeschreibung von Tetzel, Leipsic, 1844), and Grone, a Roman Catholic (Tetzel und Luther, oder Lebensgeschichte und Rechtfertigung des Ablasspredigers und Inquisitors Br. Johann Tetzel, etc, Soest, 1853).