Surgery, a practical treatise with special reference to treatment / by C.W. Mansell Moullin ; assisted by various writers on special subjects.

  • Mansell-Moullin, C. W. (Charles William), 1851-1940
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: Surgery, a practical treatise with special reference to treatment / by C.W. Mansell Moullin ; assisted by various writers on special subjects. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    cultivations, and which have been shown to be capable of causing tetanic convul- sions. That the disease in animals usually begins in or near the seat of inoculation is not really very much to the i)oint, for such cases, though they may be rare, are certainly met with in man. [Kitasato obtained, by an ingenious process, a pure culture of the tetanus bacillus of Nicolaier, and by inoculation of animals repro- duced the disease. Verneuil is of opinion that contact with horses is a necessary factor in the causation of tetanus. Larrey long ago cited instances where the use of soiled straw taken from a stable and used by wounded soldiers as bedding was followed by tetanus. The tetanus bacillus is, however, one of the most widely distributed in nature. Brieger has also found from pure cultures of the tetanus bacillus certain toxalbumins—tetanin, tetanotoxin, spasmotoxine, and spasmodine —and with these poisons he produced tetanus. It therefore now seems probable that the products of the tetanus bacilli are the immediate cause of the disease.] The post-mortem appearances in tetanus are not distinctive in any way. [Inoculations made from cadavers dead from tetanus have reproduced the disease.] Occasionally evidence of neuritis is found, but it is decidedly rare ; rupture of muscles and engorgement from asphyxia might be expected. In one or two instances curious rounded points visible to the naked eye have been found in the spinal cord and medulla oblongata ; they stained readily with carmine and logwood, were apparently homogeneous, and pushed aside the nerve fibres round them; but it is not known what significance is to be attached to them. Dilatation of the perivascular lymphatics in the brain has also been described. Symptoms.—Premonitory symptoms are rare. The first definite sign is usually jiain and stiffness about the muscles of the jaw and neck ; the patient com- plains of sore throat or stiff neck, and imagines he has caught cold. Then it is noticed that the mouth cannot be opened to its full extent, though it can still be closed, and that mastication and deglutition are difficult. Every attempt brings on painful spasms, and seems to make the contraction worse. By degrees, some- times rapid, sometimes slow, the painful contraction and the rigidity extend to other muscles near. The orbicularis oris may be contracted; more frequently the lips are drawn apart (risus sardonicus),-the neck is drawn back so that the head bores its way into the pillow, the thorax becomes rigid and the abdomen hard and board-like; often there is a fearful pain extending from the ensiform cartilage backward ; respiration becomes shallow and rapid; the forehead is bathed with sweat; the pulse small and feeble; and the whole face expressive of the most intense anxiety and suffering. Gradually, as the disea.se advances, all the muscles of the trunk become hard and rigid ; the thighs and legs are extended or drawn apart, and the shoulders and arms thrown out. The fingers and wrists usually escape. Meanwhile the convulsions become more and more severe, and the interval shorter. Paroxysmal attacks with the most violent contractions come on every few minutes, and with every sound or breath of air ; the face is distorted ; the body wrenched and twisted with the utmost violence into inconceivable positions ; the limbs jerked wildly about, until at length the muscles themselves give way or are ruptured. Consciousness is retained to the last. The pain in the acute forms is agoniz- ing. Sleep is impossible, except in short snatches from sheer exhaustion ; it is said that then there is slight relaxation. The bowels are confined, the urine scanty, and toward the end the temperature often begins to rise, and it may continue after death until it reaches 112° F., or even more. Sometimes, just at the end, there is a brief lull in the severity of the symptoms, but no hope is to be derived from that. Death is generally due to asphyxia or heart-failure. If this does not happen, the exhaustion may be so extreme as to prove fatal of itself. In chronic cases the convulsions diminish in intensity until only a certain degree of tonic contraction is left; a relapse is always possible so long as the slightest trace persists. Prognosis.—Acute tetanus is nearly always fatal; death may occur in four
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