In attempting the cure of Tetanus, the first object is to remove the source of irritation, if it depends upon any obvious mechanical cause ; if it proceeds from a wound of any kind, it has been recommended to di vide the nerve which passes from the wounded part to the brain ; but this practice has not been attended with the expected relief, nor has even amputation of the limb been successful, when the disease has once taken possession of the constitution. Applying caus tics, or heating stimulants, as the oil of turpentine, to the wound, so as to produce a copious suppuration in the part, has been thought to afford a probable means of re lief, upon the principle that where Tetanus has followed from a mechanical injury, the discharges have assumed an unhealthy aspect. It is, however, extremely doubt ful whether any advantage has been derived from these practices, and at all events our main reliance is to be placed upon internal remedies, of which the most important is opium. When the symptoms of the disease unequivocally manifest themselves, we must im mediately have recourse to this medicine in frequently repeated doses; the extent of the dose must depend upon the effect which it produces on the system; but the quan tity which has been taken in this disease is very large, and much more than could have been borne in the or dinary condition of the functions. Many substances have been united with opium, upon the idea of increas ing its efficacy, but it may be questioned whether they are of any essential benefit ; perhaps indeed in those cases where there is much fever, a combination of opium and ipecacuanha may be preferable to opium alone. Some cases are upon record where idiopathic Tetanus has been relieved by dashing cold water over the patient, or by immersing him in the cold bath, but this has probably been in the slighter cases only, and in Tetanus from wounds has been found completely useless, perhaps even injurious; for in such cases the sensations of the patient rather indicate the application of warmth than of cold to the surface. Besides the in ternal exhibition of opium, it has been found to pro duce its appropriate action on the system, by being rubbed on the skin in the form of ointment ; when the process of friction does not add to the sufferings of the patient, this will at all times be found a useful adjunct to the internal exhibition of the remedy ; and where the deglutition is very much impeded, we are under the necessity of entirely depending upon it. Mercury, which in modern times has been regarded by some au thors as a universal panacea for all complaints, has been employed in Tetanus, and, as we are informed, with the usual success ; but it has not produced the same good effect in other hands. Wine or ardent spi rits, taken in large quantities, has been recommended in Tetanus, and some cases are upon record where this plan has appeared to be successful ; but upon the whole we think it is less effective than opium, and we percieve no motive for preferring it. Purgatives in this, as in all the Neuroses, are valuable adjuncts to our other remedies, but in Tetanus we are not to depend upon them as affording a radical means of cure.
Perhaps the only idiopathic disease which can be considered as belonging to the next genus of the Spasmi, those which consist in an irregular action of the involuntary muscles, is Colica. Colic consists in pain of the bowels, especially characterized by a twist ing sensation in the umbilical region, accompanied with spasmodic contraction of the abdominal muscles, and obstinate costiveness. There are many varieties of Colic, which are clearly referable to different exciting causes, but which nearly resemble each other in their symptoms : the peculiar state of the digestive organs, and of the biliary secretion ; various articles of food, or merely an excessive quantity taken into the stomach ; retention of the faces ; the application of cold anc: moisture to the feet ; perhaps worms; and certain me tallic poisons, particularly lead. It has been ascribed
to a metastasis of gout from the extremities, and it has been supposed that the intestines were subject to Rheu matism ; but whatever be the origin of the disease, it is probable that its proximate cause is always the same, an irregular contraction of the muscular fibres of some portion of the intestinal canal. When this state pro ceeds to a very violent degree, the peristaltic motion of the bowels is entirely inverted, and the faeces are even discharged by vomiting ; occasionally the bowels have their action so much deranged, that one portion which is much contracted is forced into another which is less so, forming what has been called an intus•susception : the disease in this aggravated form has been termed liens, or the Iliac passion. There is no fever necessarily connected with Colic, and by this circumstance it may be distinguished from Enteritis ; another diagnosis is, that in Enteritis the pain of the abdomen is increased by pressure, whereas in Colic it is perhaps rather re lieved by this means ; but although the diseases are essentially different from each other, yet Colic, if not speedily relieved, is liable to produce inflammation. On this account, when it is violent, we are frequently obliged to commence with blood-letting, which both obviates the subsequent tendency to the inflammatory state, and renders the exhibition of purgatives more effectual. The great object, however, is to procure the discharge from the bowels ; but when the vomiting is severe, this is a point which it is often difficult to ac complish. For the most part it is dangerous to pro mote the tendency to vomiting, lest we should produce an inversion of the peristaltic motion of the intestines, yet sometimes the stomach is relieved by the free eva cuation of its contents, and occasionally a single dose of opium is useful under these circumstances. We are, however, to place our main dependence upon pur gatives, administered in frequently repeated doses, of such strength as the stomach will bear, and in the form which is least obnoxious by their bulk or their sensible qualities. The operation of purgatives is much pro moted by injections, which should be as capacious as the parts will receive ; and we may render them more active by mixing some cathartic ingredient with them.
The choice of the purgative depends upon a variety of circumstances, connected with the habits and constitu tion of the patient, for which it is not easy to lay down any general rules. Some practitioners place great con fidence in calomel, tither alone or combined with sonic drastic, as colocynth or scammony ; where the sto mach will retain it, and the disease is not too violent, olcurn ricini is a safe and effectual remedy, and in most cases the neutral salts, especially the sulphate of mag nesia, will be found useful adjuncts to the more pow erful remedies. The patient is often much distressed flatulence, for which he may obtain temporary relief by carminatives and stimulants ; the latter, how ever, must always be given in small doses. When the bowels have been fully evacuated, the pain is generally relieved or much mitigated ; but if this lie not then the case, tie may safely administer opium. Should there be much soreness of the abdomen, which is increased by pressure, indicating a tendency to inflammation of the peritot.xum or the neighbouring parts, leeches or blis ters will be proper ; and in most cases we shall find re lief from hot lomentations, or the warm bath. Persons who have suffered from Colic should be extremely cautious with respect to their diet, and should carefully guard against external cold, as it is found that a severe fit of the complaint always lays the foundation for subse quent returns of it, which may terminate either in acute inflammation, or may lead to some organic disease of the part, less rapid in its progress, but equally fatal in its ultimate result.