A treatise on tetanus : being the essay for which the Jacksonian Prize for the year 1834 was awarded by the Royal College of Surgeons in London / by Thomas Blizard Curling.

  • Curling, Thomas Blizard, 1811-1888.
Date:
1837
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on tetanus : being the essay for which the Jacksonian Prize for the year 1834 was awarded by the Royal College of Surgeons in London / by Thomas Blizard Curling. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    firmly contracted in the disease, nor is such a state of it peculiar to those who have died from Tetanus. That this organ, participates in the spasms which attack the voluntary muscles is an opinion that, notwithstanding the high authorities to the contrary, has always appeared to me exceedingly problematical. That it can be an ordi- nary symptom of the disease is certainly impossible; for it must be obvious, that if such were the case, the action,of the heart, instead of being accelerated, which is universally admitted to be its condition in Tetanus, must be greatly retarded, or even altogether arrested so long as the spasm lasts. Although the pulsations of the heart vary both in regularity and frequency, yet the longest period of inter- mission endures so short a time, that the organ can never be considered as remaining in a state of permanent spasm, which is the state of the voluntary muscles in Tetanus. Such a condition of this important organ is certainly incompatable with the continuance of life. Without, however, venturing to deny that the heart ever becomes affected with spasm, I consider that there is no evidence proving such to be the fact, or even rendering it probable, and that it is little better .than a gratuitous assumption to account for the somewhat sudden manner in which the disease frequently termin- ates, in this way. Dr. Parry has, however, gone further, and has attempted to establish grounds for forming a probable conclusion as to the event of the disease by attending to the state of the pulse. He says, If in an adult the pulse, by the fourth or fifth day, does not reach one hundred or perhaps one hundred and ten beats in a minute, I believe the patient almost always recovers. If, on the other hand, the pulse on the fourth day is one hundred and twenty or more in a minute, few instances will, I apprehend, be found in which he will not die.* The accuracy of a prognosis founded upon the state of the heart's action, was verified in six instances. I regret that the state of the pulse having been so rarely recorded in the reports of the cases composing the table, it is impossible to obtain any satisfactory data upon this point; but Dr. Parry s rule is not sustained by the testimony of other writers of experience. Dr. Morrison, who had ample opportunities for observation in Demerara, states that the pulse seldom exceeds eighty. In a boy, who full a victim to the disease on the third day, in the absence ot spasms the pulse was ninety-eight, but he has never remarked it higher than thist. Dr. Hennen found the pulse in the cases that he had met with, astonishingly unaffected}, and the same was observed by Sir James Macgregor||. In cases 19, 33, 36,55, 57, 60, 87, 90, 95 115, and 125, although the pulse exceeded one hundred and ten beats the patients recovered. In all those cases which I have wit- nessed, the action of the heart, as well as the respiratory movements, * Lib. cit. p. 18. t Treaties on Tetanus. Newry, 181(5. { Principles of Military Surgery, third edition, London, 1829. y Medico-chirurgical Transactions, vol. vi.