Surgery : its theory and practice / by William Johnson Walsham.

  • William Walsham
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Surgery : its theory and practice / by William Johnson Walsham. Source: Wellcome Collection.

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    drawn to one or otlier side [pleurostliotonos). Tlie skin is bathed in persi^iration, the urine concentrated and high coloiu'ed, and the bowels are obstinately confined. The temperatm'e may remain normal, or be but sHghtly raised; though sometimes shortly before death it runs very high, and has been known to register 112' Fahr. The patient is unable to sleep, but the intellect continues clear to the end. Death may occur from spasm of the glottis, spasm of the respiratory muscles, or from ex- haustion or syncope. Eecoverj- hardly ever takes place when the symptoms are acute, but if the patient survive till the twelfth day the jDrognosis is more favourable, and becomes more and more so evei-j- day. Diagnosis. —From strychnia poisoning and hydi'O- phobia, tetanus is distinguished by the sjjasms being of a tonic instead of a clonic character, and fiu'ther from hydi'ophobia by the absence of hallucinations and the discharge of viscid saliva, signs which are characteristic of that affection. Treatment.—Nothing in the way of sjiccifics has hitherto been found for the disease, ( 'urare, Indian hemp, Calabar bean, eseiine, and numerous other drugs have been tried, and signally failed, at least in the acute form of the disease. Chloroform, although it prevents the .spasms while the patient is under its influence, appears to lie of no jtermanent benefit. All that can bo done is to attempt to tide the patient through the first few daj-s in the hope that the affection may become chronic. Thus his strength must be supported with fluid nourishment, administered by the roctiun if he is unable to swallow, ;ind the sjiasms as much as possible prevented by the most absolute quiet, the avoidance of all sources of irritiitiou, and the employ- ment of such sedatives as Indian ]iein]i, bromide of potassium, chloral or opiuui. If the latter is chosen, it should be ]iushed to the extreme verge; of safety. In the few cases 1 have seen recover, the iiatient was treated by excessive doses of this drug. The bowels should be cleared by purgatives or eneinata. Locally, under any circumstances, means .should be taken to render the Avound ase]itic. and in the light of recent researches that seem to show that tetanus is due to a poison generated by micro-organisms which exist only in the wound, the prac- tice of free incision of the injured part and subsequent thorough cauterization on the first appearance of the syni]itonis, cMninienils itself for ado]ition.
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