TETANUS (TiTavos, derived from vcivco, to stretch) is both a generic and a specific term : generically, it may be defined to be a more or less violent and rigid Tam of many or all of the muscles of voluntary motion ; the name is also particularly applied (as will be seen hereafter) to one of the species of this affeetioh. Both the disease and also its name are as old as the time of Hippocrates ; and, as it is proved by experience to be mdcb more frequent in warm climates, the ancient physicians probably had peculiar advantages in observing it, and accordingly seem to have paid particular attention to it.
"Tetanic spasms," says Aretmus (' De Caus. et Sign. Morb. Acut.; lib. i., cap. 6, p. 6, ed. Kuhn), "are attended with severe pain, and prove rapidly fatal, and by no means readily admit of relief ; they make their attack on the muscles and tendons of the jaws and neck, but impart the disease to every other spot, for all parts become sympathetically affected with those which were primarily assailed. There are three forms of the convulsions : the straight, the backward, and the forward. The straight one is true Tetanus, when the patient is stretched straight and inflexible ; the backward or forward varieties have their name from the direction and locality of the tension ; hence the deflexion of the patient backwards is termed opisthotonos (Osier06 Tovos), from the nerves being affected in this direction ; while, if the bending be forward, by the nerves in front, it is termed emprosthotonos (?,corpooOOToves), for tons (Topes) is a term which signifies both a nerve and tension." The three forms of the disease mentioned by Aretmus are described by most of the ancient writers : the species called trismus, or locked jaw (which is the name applied to it when the spasms are confined to the muscles of the jaw or throat), forms a fourth in modern authors ; and to these has been added a fifth, under the name pleurosthotonos (TAtupocrOoTovos), which signifies that the body is drawn to one side. These different terms applied to tetanic affections do not imply so many particular diseases, but only the seat and various degrees of one and the same complaint. Trismus is invariably a part of each of the
other varieties. This subdivision of the disease is of little or no practical importance; but a much more essential division is into acute or chronic, according to its greater or less intensity. The former kind is exceedingly dangerous and usually fatal ; while the latter, on account of the more gradual progress of the symptoms, affords more opportunity of being successfully treated. (Larrey, in 3141n, de Chirurgie Militaire' tome i.) Tetanus is also divided into traumatic, or that arising from a wound, which is also occasionally termed symptomatic; and into idiopathic, or that which proceeds from other causes.
Traumatic tetanus sometimes comes on in a surprisingly sudden manner, and quickly attains its most violent degree. The most rapidly fatal case that has ever been recorded is one that we have on the authority of the Into Professor Robison of Edinburgh. It occurred in a negro, who scratched his thumb with a broken china plate, and died of tetanus a quarter of an hour after this slight injury. Most commonly, however, the approaches of the disorder are more gradual, and it slowly advauces to its worst stage. In this sort of case the commence ment of the disorder is announced by a sensation of stiffness about the neck, a symptom which, increasing by degrees, renders the motion of the head difficult and painful. In proportion as the rigidity of the neck becomes greater, the patient experiences in the throat a sense of dryness and soreness, and about the root of the tongue an uneasiness, soon changing into a difficulty of mastication and swallowing, which, after a time become totally impossible. The attempt at deglutition is attended with convulsive efforts, especially when an endeavour is made to swallow liquids; and so great is the distress which accompanies these convulsions, that the patient becomes very reluctant to renew the trials, and occasionally refuses all nourishment; sometimes it even inspires him with a dread of the sight of water, and a great resem blance to hydrophobia is produced.