The surgeon's vade mecum : a manual of modern surgery / by Robert Druitt.

  • Druitt, Robert, 1814-1883.
Date:
1854
Catalogue details

Licence: Public Domain Mark

Credit: The surgeon's vade mecum : a manual of modern surgery / by Robert Druitt. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    25/816 (page 5)
    alindst every other nervous afiection. (7.) Lastly, there is the hustcrical tetanus; in whieii all the outward sym])toiiis of tetiums are produced, as a consoqueuce of an hysterical state of the system. SKCTIOX II. ACUTE TETANUS. SvMPTOiis.—The patient first complains of stiffness and pain of the neck and jaws, as from a cold ; his voice is husky; it is difficult for him to put out his tongue, and liis countenance is observed to have a peculiar expression, resembliuo- a painful smile, because the corners of the mouth and eyes are drawn outwards by incipient spasm of the facial muscles. In the next place, the muscles of mastication and de- glutition become fixed and rigid with spasm, so that tlie mouth is permanently closed, and there is great flilHculty of swallowing, espe- cially liquids. To these symptoms succeed a fixed pain at the pit of the stomach shooting to the back, and a convulsive ditHculty of breath- mg, indicating that the diaphi-agm and muscles of the glottis are atiected; and the spasm now extends to the muscles of the trunk and limbs, rendering them completely fixed and rigid. The abdomen feels remarkably hard ; there is obstinate constipation, and frequently difficult micturition from spasm of the perinajal muscles; the pupils are con- tj'acted ; and the saliva flows from the mouth, because the patient is unable to swallow it. This spasm never ceases entirely ; but it occa- sionally has a lull, and then comes on again in fits of greater violence. .Such fits are easily brought on by any disturbance, such as an attempt to swallow, or by any other bodily movement or mental excite- ment, and most i-emarkably by slight causes affecting the surface of the skin ; such as currents of cold air. There are generally some snatches of rela.vation during sleep. Meanwhile the intellect is undis- turbed, and thejiulse may be natural, except during a severe paroxysm, which quickens it, and causes perspiration and thirst. Ter.vii.vation.s.—(1.) If the case is about to end fiitall,/, the pa- roxyms become more frequent and violent, and the breathing more and more emban-assed by spasm of the dia]ihragm and of the muscles of the glottis ; and at last the patient dies, either from exhaustion or from sutTocution;—either because the nervous system is worn out by the violence of the spa^sm ; or because the i-espiration is suspended enough to cut oil the necessary supply of arterial blood fi-om the bi-ain, imd solo induce insensibility. The most usual )wri„,l of death is the third or tourth day; sometimes it is postponed till the eighth or tenth, but rarely later Or, the other hand, there is the case *'recorded of a negro who injured his hand, an,l died of tetanus in a quarter of an hour; mul cases of death within twenty-four hours are by no means unconunon. {2.) When acute tetanus terminates favourably, still the patient's re- covery m.ay not be complete for weeks or months ;-partly because of I'l lacerations which the muscles have sulli'i-ed,-partly because ot the remaining tendency to spasm, which very slowly yields * lices'a Eiicj tliJiHediii, Al l. Tetanus.