The interval between the reception of the injury and the first tetanic symptoms com monly varies from the 4th to the 14th day, and rarely exceeds 22 days, some time in the the second week being the most common period. As a general rule, the more rapidly the disease comes on, the more fatal will be the result.
Mere trismus or lock-jaw may be induced.by affections of the teeth, especially by dif ficult dentition of the wisdom-teeth; but this is a purely local affection, in which the muscular contraction, though persistent, is never increased by painful spasmodic parox ysms, and which usually disappears on the removal of the exciting cause; and the gen eral knowledge of this fact may tend to remove unnecessary terrors. Hysteria sometimes mimics the phenomena of tetanus with marvelous fidelity; and hydrophobia and tetanus have been mistaken for one another, in consequence of the spasm of tetanus sometimes affecting the muscles of deglutition, and inducing a fear of swallowing. There is, how ever, seldom any serious difficulty in detecting the difference between tetanus and any other disease. But there is a form of poisoning which produces almost every symptom of tetanus, and which may be termed artificial tetanus. If strychnia or brucm, or their salts, or vegetable matter containing either or both of these alkaloids, as nux vomics, St. Ignatius's beans, or the juice of the upas tiente, be administered, either by the stomach or by inoculation, into the system, it induces all the symptoms of intense tetanus, and there is no test by which to distinguish the results of the disease and of the poisoning, except that, according to Dr. Christison, the disease never proves so quickly fatal as the rapid cases of poisoning with strychnia. See Nux VOADCA, And those who wish to
study more minutely the comparative symptoms of strychnia-poisoning and tetanus, may consult the authorized Report of Palmer's Trial.
In the way of treatment, almost every known medicine has been prescribed, and whatever plan be adopted, a vast majority of the cases terminate fatally. As is the case with certain fevers, so tetanus seems to have a definite course to run; and as Mr. Poland wisely suggests: "All we can do is to enable our patient to weather out the storm by giving him as much strength as possible, and not adding fuel to the fire by all sorts of applications and internal remedies, which have over and over again signally failed. If we can help our patient on one day after another, we gain much: constant watching and constant attention are required by night as well as by day; an unflinching perseverance on the part of the sufferer in carrying out these views; besides the avoidance of all causes of excitement, and more especially the cold air or winds; taking care to preserve a uniform temperature as much as possible." When, in consequence of the strong con traction of the muscles of the jaw, it is impossible to open the patient's mouth, food and physic should be introduced into the stomach by means of a flexible tube passed through one of the nostrils.
The peculiar form of tetanus that occurs in newly.born children differs in so many respects from the disease described in this article that we shall briefly notice it in a sep arate article under the title of TRISAIUS NASCENTRIAl.