Watson abridged : synopsis of the Lectures on the principles and practice of physic, delivered at King's College, London / by Thomas Watson.

  • Sir Thomas Watson, 1st Baronet
Date:
1867
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Licence: Public Domain Mark

Credit: Watson abridged : synopsis of the Lectures on the principles and practice of physic, delivered at King's College, London / by Thomas Watson. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    of potassium is often eligible. If the brain is likely implicated, treat dili- gently. If evidences exist of chronic disease in the petrous portion of tbe temporal bone, as tenderness of the mastoid process, deafness, or pro- tracted discharge from the ear, an imperfect state of the membrane tympani, very active treatment is of little use. Employ counter irritation and the remedies of otitis. Purgatives and blisters sometimes do good. Sometimes the patient loses the powers of motion and sensation in almost every part of the body, and yet lives for a long time. LECTURE XXXII. Tetanus.—There are two kinds of spasms, tonic and clonic. Tbe former is a long-continued contraction of the muscles, the relaxation taking place slowly, after some time, the contractions again, after an interval, perhaps, coming on, as in cramps in the leg ; the latter is a repeated, forcible, and quick succession of contractions, the relaxations being as sudden and frequent as in convulsions. In disease the two are sometimes mixed. Symptoms. &c.— Tetanus (-rixw, to stretch) is characterized by an in- voluntary, long-continued, violent, and painful contraction, cramp of the voluntary muscles of various parts, or of nearly the whole body. Generally the muscles of the neck, jaws, and throat, are the earliest affected. There are difficulty and uneasiness in turning the head and opening the mouth ; at last the jaw closes gradually, but firmly, or suddenly. Four-fifths of the cases begin thus, with trismus or loeked-jaw. The muscles concerned in swallowing become affected. There is soon an acute pain at the lower part of the sternum, piercing to the h ick and depending ou cram]) of the diaphragm. The pain is subject to aggravations in paroxysms, each paroxysm being attended by increased contraction of other implicated parts. The spasms extend to the trunk, extremities, face, and finally to the tongue, hands and fingers. The hands and fingers are sometimes movable. All the implicated muscles, from first to last, continue con- tracted, hard, and swelled, in their centres. There are exacerbations, however, of the spasm, perhaps every ten minutes or so, and lasting for two or three minutes, and then the muscles return to their former state. The slightest cause, change of posture, speakin<r, &c, may bring on the exacerbation. As the disease advances, these paroxysms become more frequent: a rapid increase in the frequency of their recurrence is a sure sign that the disease is severe and dangerous. The more speedily the intervals between the paroxysms shorten, the worse it is. The spasms may give way during sleep, but return after. When the muscles of the back are the most affected, as is usually the case, the body is bent back- ward (opisthotonos), and the patient rests on his head and heels. When the body is bent forward, it is emprosthotonos; when to one side, pleuros- thotonos, or tetanus lateralis. Sometimes the whole body is rigidly extended. In all these forms, the prognosis is the same. During a fit, the forehead is corrugated, the brow knit, the eyeballs motionless, staring, the nostrils spread, the angles of the mouth drawn back, the teetli set, (risns sardonicus.) The pain, especially that at the sternum, is intense. It is worse during the exacerbations. Sometimes there may be no pain. The violent contrac- tions sometimes break bones and teeth. There are almost always obsti- nate costiveness from spasmodic closure of the anus, and perhaps from the medicine. The stools are usually very offensive and unnatural. There is no fever. The pulse and respiration are quickened, and often a sweat
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