CHAPTER VI. ON TETANUS
TETANUS, in all its varieties, is a spasm of an exceedingly
painful nature, very swift to prove fatal, but neither easy to be
removed. They are affections of the muscles and tendons
about the jaws; but the illness is communicated to the whole
frame, for all parts are affected sympathetically with the primary
organs. There are three forms of the convulsion, namely,
in a straight line, backwards, and forwards. Tetanus is in a
direct line, when the person labouring under the distention is
stretched out straight and inflexible. The contractions forwards
and backwards have their appellation from the tension
and the place; for that backwards we call Opisthotonos; and
that variety we call Emprosthotonos in which the patient is
bent forwards by the anterior nerves. For the Greek word
τόνος is applied both to a nerve, and to signify tension.
The causes of these complaints are many; for some are apt
to supervene on the wound of a membrane, or of muscles, or of
punctured nerves, when, for the most part, the patients die; for,
"spasm from a wound is fatal." And women also suffer from
this spasm after abortion; and, in this case, they seldom recover.
Others are attacked with the spasm owing to a severe
blow in the neck. Severe cold also sometimes proves a cause; for
this reason, winter of all the seasons most especially engenders
these affections; next to it, spring and autumn, but least of all
summer, unless when preceded by a wound, or when any strange
diseases prevail epidemically. Women are more disposed to tetanus
than men, because they are of a cold temperament; but
they more readily recover, because they are of a humid. With
respect to the different ages, children are frequently affected,
but do not often die, because the affection is familiar and akin
to them; striplings are less liable to suffer, but more readily
die; adults least of all, whereas old men are most subject
to the disease, and most apt to die; the cause of this is
the frigidity and dryness of old age, and the nature of the
death. But if the cold be along with humidity, these
spasmodic diseases are more innocent, and attended with less
danger.
In all these varieties, then, to speak generally, there is a
pain and tension of the tendons and spine, and of the muscles
connected with the jaws and cheek; for they fasten the lower
jaw to the upper, so that it could not easily be separated even
with levers or a wedge. But if one, by forcibly separating
the teeth, pour in some liquid, the patients do not drink it but
squirt it out, or retain it in the mouth, or it regurgitates by
the nostrils; for the isthmus faucium is strongly compressed,
and the tonsils being hard and tense, do not coalesce so as to
propel that which is swallowed. The face is ruddy, and of
mixed colours, the eyes almost immoveable, or are rolled about
with difficulty; strong feeling of suffocation; respiration bad,
distension of the arms and legs; subsultus of the muscles;
the countenance variously distorted; the cheeks and lips tremulous;
the jaw quivering, and the teeth rattling, and in certain
rare cases even the ears are thus affected. I myself have beheld
this and wondered! The urine is retained, so as to induce
strong dysuria, or passes spontaneously from contraction of
the bladder. These symptoms occur in each variety of the
spasms.
But there are peculiarities in each; in Tetanus there is tension
in a straight line of the whole body, which is unbent and
inflexible; the legs and arms are straight.
Opisthotonos bends the patient backward, like a bow, so
that the reflected head is lodged between the shoulder-blades;
the throat protrudes; the jaw sometimes gapes, but in some
rare cases it is fixed in the upper one; respiration stertorous;
the belly and chest prominent, and in these there is usually
incontinence of urine; the abdomen stretched, and resonant if
tapped; the arms strongly bent back in a state of extension;
the legs and thighs are bent together, for the legs are bent in
the opposite direction to the hams.
But if they are bent forwards, they are protuberant at the
back, the loins being extruded in a line with the back, the
whole of the spine being straight; the vertex prone, the head
inclining towards the chest; the lower jaw fixed upon the
breast bone; the hands clasped together, the lower extremities
extended; pains intense; the voice altogether dolorous; they
groan, making deep moaning. Should the mischief then seize
the chest and the respiratory organs, it readily frees the patient
from life; a blessing this, to himself, as being a deliverance
from pains, distortion, and deformity; and a contingency less
than usual to be lamented by the spectators, were he a son
or a father. But should the powers of life still stand
out, the respiration, although bad, being still prolonged, the
patient is not only bent up into an arch but rolled together
like a ball, so that the head rests upon the knees,
while the legs and back are bent forwards, so as to convey
the impression of the articulation of the knee being dislocated
backwards.
An inhuman calamity! an unseemly sight! a spectacle painful
even to the beholder! an incurable malady! owing to the
distortion, not to be recognised by the dearest friends; and
hence the prayer of the spectators, which formerly would have
been reckoned not pious, now becomes good, that the patient
may depart from life, as being a deliverance from the pains
and unseemly evils attendant on it. But neither can the
physician, though present and looking on, furnish any assistance,
as regards life, relief from pain or from deformity. For
if he should wish to straighten the limbs, he can only do so
by cutting and breaking those of a living man. With them,
then, who are overpowered by the disease, he can merely sympathise.
This is the great misfortune of the physician.
