This is the explanation of the fact that the wound may be thoroughly cleansed, and even healed, and yet the disease arise, because of the poison which has already passed into the circulation before the wound had been cleared of the organisms. It is more common in warm than cold climates.
Symptoms begin with stiffness and pain in muscles of the jaw and throat, giving the the idea that he has caught cold. With the advance of the disease, swallowing becomes difficult, even opening the mouth becomes not easy, and at length the mouth is kept firmly closed, and the jaw fixed, hence the name lock jaw. Spasms of the muscles of the mouth draw down the corners of the mouth, showing the teeth and giving the person a grinning appearance—sardonic grin. The extension of the spasm involves the muscles of the back, belly, and limbs, so that the patient lies on his back quite rigid. The chief muscle connected with breathing—the diaphragm—may be at tacked, so that the breathing is difficult and shallow. A cramp-like pain accompanies the spasm, becoming every now and again agoniz ing. While the stiffness of the muscles is more or less constant, it is liable to great aggrava tion at more or less regular intervals. During the aggravations the rigidity of the muscles may become so intense that the person is arched backwards by the excessive contraction of the muscles of the back, a condition called opisthotonus (Greek opisthe, backwards, and teino, I bend), or bent forwards by the mus cles of the belly —emprosthotonus (empros then, forwards). Movement, light, sound, noise, irritation of any sort will bring on the aggra vation. The laying of the warm hand on the patient's forehead may be seen to increase the spasm of the muscles of face and neck, by the increased retraction of the corners of the mouth. The paroxysms occur every fifteen or ten minutes, and last a few seconds or even minutes. During them profuse sweating breaks out. The pulse is weak and fast, the tempera ture is higher than usual, and often indicates the near approach of death by rapidly rising. Thirst is great. Consciousness is usually per fect even till the end, which usually occurs between the third and fifth day, from suffoca tion during a paroxysm, or from exhaustion. The symptoms are very like those of poison ing from nux vomica or its active principle strychnine, but in the latter case they develop more quickly, and run a more rapid course to death.
Treatment should proceed on two lines. The wound should be cleansed by such means as will destroy and remove the organisms; but this is difficult. The best agents seem to be a solution (1 in 1000) of perchloride of mercury (Vol. II., p. 448), or iodine 2 per cent dissolved with iodide of potassium in water. The second line of treatment consists of the injection of anti-tetanic serum (Vol. I., p. 514). The serum has been reduced to powder, and dusting a suspicious wound with it is said to be able to prevent the occurrence of the disease.
These are obviously methods requiring surgical knowledge and skill.
Apart from these two methods of treatment, much may be done to diminish the s.ufering, little to arrest the disease. Since the smallest thing can provoke a paroxysm, the utmost quiet is necessary. The patient should lie in a darkened room. All jarring of doors, stumbling against chairs, &c., should be rigor ously avoided. A quiet attendant, and only one, should wait upon him, and no visitors ought to be permitted. Early id the progress of the disease a strong dose of calomel and jalap, to produce free movement of the bowels, should be given, so that the patient need not be troubled with this afterwards. Various medicines for relieving the spasm have been tried, belladonna, nicotine (the active principle of tobacco), Indian hemp, calabar bean, woorari (the Indian arrow poison), and others. The pro longed administration of chloroform is of use. Such treatment, however, requires medical aid.
Tetany is an affection in which painful contractions of the muscles of the forearm and wrist, and sometimes of the foot, occur. It does not affect the jaw and back. It is commonest in children, associated sometimes with rickets, and in women with pregnancy and nursing.
Symptoms. — The thumb and fingers are chiefly affected, the thumb being folded across the palm, and the fingers drawn into a cone, and the hands are usually bent. The spasms also frequently affect the toes, the great toe being bent under the others, which are spas modically curved towards the sole. In severe cases other muscles and groups of muscles are involved. These spasmodic movements are usually associated with disturbances of sensa tion, such as dizziness, noises in the ears, sensations of numbness. The attacks of spasm come and go, lasting some minutes or even half an hour, and separated by intervals of a clay or two, or sometimes weeks. In children they sometimes keep recurring for weeks, continuing ' during sleep. In children, crowing (child crowing) is often associated with the disease.
Treatment—The muscular cramps and nerve pains are the indications of a highly irritable nervous system, which may be the result of a bad condition of general health, such as poor nourishment and bad sanitary surroundings readily produce in children. Disordered states of stomach and bowels frequently attend the disease. In such disorders, faulty digestion occurs, leading to the production of materials in stomach or bowels which, absorbed into the blood, act as nerve poisons. Thus tetany has been observed, even in the adult, to accompany cases of dilated stomach. Such conditions should always be carefully searched for.
Bromide of potassium relieves the spasm, in 5-grain doses thrice daily to children.