2. The acrimony of the meconium retained in the bowels.
3. Cold air acting upon the body, after it has been heated by the air of a hot room.
4. Smoke is supposed to excite it, in the negro quarters in the West-Indies.
It is unknown, Dr. Winterbottom informs us, among the native Africans in the neighbourhood of Sierra Leone.
I am aware that it is ascribed by many physicians to only one of the above causes; but I see no reason why it should not be induced by more than one cause in infants, when we see it brought on by so many different causes in grown people.
The tetanus is not confined to the human species. It often affects horses in the West-Indies. I have seen several cases of it in Philadelphia.
The want of uniform success in the treatment of this disease, has long been a subject of regret among physicians. It may be ascribed to the use of the same remedies, without any respect to the nature of the causes which produce it, and to an undue reliance upon some one remedy, under a belief of its specific efficacy. Opium has been considered as its antidote, without recollecting that it was one only, of a numerous class of medicines, that are all alike useful in it.
Tetanus, from all its causes, has nearly the same premonitory symptoms. These are a stiffness in the neck, a disposition to bend forward, in order to relieve a pain in the back, costiveness, a pain about the external region of the stomach, and a disposition to start in sleep. In this feeble state of the disease, an emetic, a strong dose of laudanum, the warm bath, or a few doses of bark, have often prevented its being completely formed. When it has arisen from a wound, dilating it if small or healed, and afterwards inflaming it, by applying to it turpentine, common salt, corrosive sublimate, or Spanish flies, have, in many hundred instances, been attended with the same salutary effects.
The disease I have said is seated in the muscles, and, while they are preternaturally excited, the blood-vessels are in a state of reduced excitement. This is evident from the feebleness and slowness of the pulse. It sometimes beats, according to Dr. Lining, but forty strokes in a minute. By stimulating the wound, we not only restore the natural excitement of the blood-vessels, but we produce an inflammatory diathesis in them, which abstracts morbid excitement from the muscular system, and, by equalizing it, cures the disease. This remedy I acknowledge has not been as successfully employed in the West-Indies as in the United States, and that for an obvious reason. The blood-vessels in a warm climate refuse to assume an inflammatory action. Stimuli hurry them on suddenly to torpor or gangrene. Hence the danger and even fatal effects of blood-letting, in the fevers which affect the natives of the islands, a few hours after they are formed. But widely different is the nature of wounds, and of the tension of the blood-vessels, in the inhabitants of northern countries. While Dr. Dallas deplores the loss of 49 out of 50 affected with tetanus from wounds, in the West-India islands, I am sure I could mention many hundred instances of the disease being prevented, and a very different proportion of cures being performed, by inflaming the wounds, and exciting a counter morbid action in the blood-vessels.
When the disease is the effect of fever, the same remedies should be given, as are employed in the cure of that fever. I have once unlocked the jaw of a woman who was seized at the same time with a remitting fever, by an emetic, and I have heard of its being cured in a company of surveyors, in whom it was the effect of an intermittent, by large doses of bark. When it accompanies malignant fever, hysteria, or gout, the remedies for those forms of disease should be employed. Bleeding was highly useful in it in a case of yellow fever which occurred in Philadelphia in the year 1794.