Locked Jaw. Tetanus.
This is spasmodic contraction, with rigidity, or stiffness, of the voluntary muscles. Sometimes this rigidity is partial, at other times universal throughout the system.
Tetanus is produced by two causes, exposure to cold (idiopathic), and bodily injuries particularly the injury of a nerve (traumatic tetanus). This last is the most frequent, perhaps the only form of the complaint.
The Symptoms are long continued, violent and painful contraction or cramp of the voluntary muscles. At first there is difficulty and uneasiness in turning the head, with inability to open the mouth easily, then the jaws close gradually, but with great firmness ; swallowing now becomes difficult, and a pain, starting from the breastbone, pierces through to the back, probably caused by cramp of the diaphragm or midriff. The cramps now extend to the muscles of the body, the limbs, the face, the tongue, etc., which continue in a state of rigid Spasm, being swelled and hard in the centre, till the disease yields, or the patient dies. At times the abdominal muscles are so tense as to make the belly as hard as a board. Occasionally the patient is drawn backward into the shape of a hoop, so as to rest on his head and heels (episthotonos); at other times he is drawn forward in the shape of a ball (emprosthotonos). All the contractions are attended with intense pain. It is the racking of the entire body with cramps like those which sometimes attack the calf of the leg. So violent are the contractions that the teeth are sometimes broken by them, and the tongue is often badly bitten. In the mean time, th6 appearance of the sufferer is frightful. The forehead is wrinkled, the brow knit, the eye ball motionless and staring, the nostrils spread, the corners of the mouth drawn back, the set teeth exposed, and all the features fixed in a ghastly grin.
The prevention of tetanus can be accomplished by thorough disinfection of all wounds, especially those due to gun powder accidents and implements around stables and manure heaps.
In 1905 the number of cases reported following the July 4th celebration was 75 per cent. less than the previous year, owing to precautions taken. It is so fatal that somewhere about 70 and 80 per cent. of those who become affected die. The most valuable treatment is the injection under the skin by a competent person of the antitoxin of tetanus, but even this, to be successful, must be administered within a short time after the wound is made to prevent the poison from invading the nervous system and causing death.
Treatment. At once upon the receipt of a wound which is suspicious the same treatment should be given as suggested for hydrophobia; on no account should the wound be closed over and allowed to heal in the early stages. If the disinfectants are not available it is much better to leave the wound exposed to the air, as the growth of these germs which is the cause of the disease is increased by exclusion of air. If the jaw becomes locked so that food cannot be taken, it may be necessary to feed the patient by means of a small rubber tube through the nostril or even the rectum, but a physician will, of course, have charge of the procedure. Ether and chloroform in desperate cases may be inhaled to ease the final struggle of the patient, or bromide of soda and chloral in large doses will also be useful.
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