When it is produced by the suppression of perspiration by means of cold, the warm bath and sweating medicines have been found most useful in it. Nature has in one instance pointed out the use of this remedy, by curing the disease by a miliary eruption on the skin[49].
If it be the effect of poisonous substances taken into the stomach, or of worms in the bowels, the cure should be begun by emetics, purges, and anthelmintic medicines.
Where patients are unable to swallow, from the teeth of the upper and lower jaw pressing upon each other, a tooth or two should be extracted, to open a passage for our medicines into the throat. If this be impracticable or objected to, they should be injected by way of glyster.
In the locked jaw which arises from the extraction of a tooth, an instrument should be introduced to depress the jaw. This has been done by a noted English dentist in London, with success.
As the habit of diseased action often continues after the removal of its causes, and as some of the remote causes of this disease are beyond the reach of medicine, such remedies should be given as are calculated, by their stimulating power, to overcome the morbid or spasmodic action of the muscles. These are:
1. Opium. It should be given in large and frequent doses. Dr. Streltz says he has found from one to two drachms of an alkali, taken in the course of a day, greatly to aid the action of the opium in this disease.
2. Wine. This should be given in quarts, and even gallons daily. Dr. Currie relates a case of a man in the infirmary of Liverpool, who was cured of tetanus, by drinking nearly a quarter cask of Madeira wine. Dr. Hosack speaks in high terms of it, in a letter to Dr. Duncan, and advises its being given without any other stimulating medicine.
3. Ardent spirits. A quack in New-England has lately cured tetanus, by giving ardent spirits in such quantities as to produce intoxication. Upon being asked his reason for this strange practice, he said, he had always observed the jaw to fall in drunken men, and any thing that would produce that effect, he supposed to be proper in the locked jaw.
4. The BARK has of late years been used in this disease with success. I had the pleasure of first seeing its good effects in the case of Colonel Stone, in whom a severe tetanus followed a wound in the foot, received at the battle of Germantown, in October, 1777.
5. The COLD BATH. This remedy has been revived by Dr. Wright of Jamaica, and has in many instances performed cures of this disease. In one of two cases in which I have used it with success, the patient's jaw opened in a few minutes after the affusion of a single bucket of water upon her body. The disease was occasioned by a slight injury done to one of her toes, by wearing a tight shoe. The signals for continuing the use of the cold bath, are its being followed by a slight degree of fever, and a general warmth of the skin. Where these do not occur, there is reason to believe it will do no service, or perhaps do harm. We have many proofs of the difference in the same disease, and in the operation of the same medicine, in different and opposite climates. Dr. Girdlestone has mentioned the result of the use of the cold bath in tetanus in the East-Indies, which furnishes a striking addition to the numerous facts that have been collected upon that subject. He tells us the cold bath uniformly destroyed life, in every case in which it was used. The reason is obvious. In that extremely debilitating climate, the system in tetanus was prostrated too low to re-act, under the sedative operation of the cold water.