I shall conclude my observations upon the tetanus with the following queries:
1. What would be the effects of copious blood-letting in this disease? There is a case upon record of its efficacy, in the Medical Journal of Paris, and I have now in my possession a letter from the late Dr. Hopkins of Connecticut, containing the history of a cure performed by it. Where tetanus is the effect of primary gout, hysteria, or fever, attended with highly inflammatory symptoms, bleeding is certainly indicated, but, in general, the disease is so completely insulated in the muscles, and the arteries are so far below their par of excitement in frequency and force, that little benefit can be expected from that remedy. The disease, in these cases, seems to call for an elevation, instead of a diminution, of the excitement of the blood-vessels.
2. What would be the effect of extreme cold in this disease? Mr. John Hunter used to say, in his lectures, “Were he to be attacked by it, he would, if possible, fly to Nova-Zembla, or throw himself into an ice-house.” I have no doubt of the efficacy of intense cold, in subduing the inordinate morbid actions which occur in the muscular system; but it offers so much violence to the fears and prejudices of sick people, or their friends, that it can seldom be applied in such a manner as to derive much benefit from it. Perhaps the sedative effects of cold might be obtained with less difficulty, by wrapping the body in sheets, and wetting them occasionally for an hour or two with cold water.
3. What would be the effect of exciting a strong counter-action in the stomach and bowels in this disease? Dr. Brown of Kentucky cured a tetanus by inflaming the stomach, by means of the tincture of cantharides. It has likewise been cured by a severe cholera morbus, induced by a large dose of corrosive sublimate. The stomach and bowels, and the external muscles of the body, discover strong associations in many diseases. A sick stomach is always followed by general weakness, and the dry gripes often paralyze the muscles of the arms and limbs. But further, one of the remote causes of tetanus, viz. cold air, often shows the near relationship of the muscles to the bowels, and the vicarious nature of disease in each of them. It often produces in the latter, in the West-Indies, what the French physicians call a “crampe seche,” or, in other words, if I may be allowed the expression, a tetanus in the bowels.
4. A sameness has been pointed out between many of the symptoms of hydrophobia and tetanus. A similar difficulty of swallowing, and similar convulsions after it, have been remarked in both diseases. Death often takes place suddenly in tetanus, as it does in hydrophobia, without producing marks of fatal disorganization in any of the internal parts of the body. Dr. Physick supposes death in these cases to be the effect of suffocation, from a sudden spasm and closure of the glottis, and proposes to prevent it in the same manner that he has proposed to prevent death from hydrophobia, that is, by laryngotomy[50]. The prospect of success from it appears alike reasonable in both cases.
Footnotes:
[49] Burserus.
[50] Medical Repository.