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 Advanced Mathematical
Techniques in Engineering
Sciences
Science, Technology, and Management Series
Series Editor
J. Paulo Davim

Advanced Mathematical Techniques in Engineering Sciences

Mangey Ram and J. Paulo Davim
Optimizing Engineering Problems through Heuristic Techniques
Kaushik Kumar, Nadeem Faisal, and J. Paulo Davim
 Advanced Mathematical
Techniques in Engineering
Sciences

Edited by
Mangey Ram and J. Paulo Davim
CRC Press
Taylor & Francis Group
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Boca Raton, FL 33487-2742

© 2018 by Taylor & Francis Group, LLC

CRC Press is an imprint of Taylor & Francis Group, an Informa business

No claim to original U.S. Government works

Printed on acid-free paper

International Standard Book Number-13: 978-1-138–55439-9 (Hardback)

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Contents
Preface............................................................................................................................................. vii
Acknowledgments..........................................................................................................................xi
Editors............................................................................................................................................ xiii
Contributors....................................................................................................................................xv

Chapter 1 Application of the Laplace transform in problems of studying

the dynamic properties of a material system and in engineering
technologies...................................................................................................... 1
Lubov Mironova and Leonid Kondratenko

Chapter 2 Fourier series and its applications in engineering...........................................35

Smita Sonker and Alka Munjal

Chapter 3 Soft computing techniques and applications....................................................57

Pankaj Kumar Srivastava, Dinesh Bisht, and Mangey Ram

Chapter 4 New approach for solving multi-objective transportation problem............71

Gurupada Maity and Sankar Kumar Roy

Chapter 5 An application of dual-response surface optimization methodology

to improve the yield of pulp cooking process..................................................91
Boby John and K.K. Chowdhury

Chapter 6 Time-dependent conflicting bifuzzy set and its applications in

reliability evaluation............................................................................................ 111
Shshank Chaube, S.B. Singh, Sangeeta Pant, and Anuj Kumar

Chapter 7 Recent progress on failure time data analysis of repairable system..........129

Yasuhiro Saito and Tadashi Dohi

Chapter 8 View-count based modeling for YouTube videos and weighted

criteria–based ranking......................................................................................... 149
N. Aggrawal, A. Arora, A. Anand, and M.S. Irshad

Chapter 9 Market segmentation-based modeling: An approach to understand

multiple modes in diffusion curves.................................................................. 165
A. Anand, R. Aggarwal, and O. Singh

v
vi Contents

Chapter 10 Kernel estimators for data analysis...................................................................177

Piotr Kulczycki

Chapter 11 A new technique for constructing exact tolerance limits on future

outcomes under parametric uncertainty..........................................................203
N.A. Nechval, K.N. Nechval, and G. Berzins

Chapter 12 Design of neural network–based PID controller for biped robot

while ascending and descending the staircase...............................................227
Ravi Kumar Mandava and Pandu R. Vundavilli

Chapter 13 Modeling fertility in Murrah bulls with intelligent algorithms................247

Adesh Kumar Sharma, Ravinder Malhotra, and Atish Kumar Chakravarty

Chapter 14 Computational study of the Coanda flow for V/STOL..................................265

Maharshi Subhash and Michele Trancossi

Chapter 15 Introduction to collocation method with application of B-spline

basis functions to solve differential equations..............................................285
Geeta Arora

Chapter 16 Rayleigh’s approximation method on reflection/refraction

phenomena of plane SH-wave in a corrugated anisotropic structure.......297
Neelima Bhengra

Index.............................................................................................................................................. 327
Preface
Mathematical techniques are the strength of engineering sciences and form the common
foundation of all novel disciplines as engineering sciences. The book Advanced Mathematical
Techniques in Engineering Sciences involved an ample range of mathematical tools and tech-
niques applied in various fields of engineering sciences. Through this book, engineers
have the opportunity to gain a greater knowledge and it may help them in the applications
of mathematics in engineering sciences.
Chapter 1 presents the rules and methods for applying the Laplace transform. Three
sections of the mathematical investigation of applied questions are distinguished: the rules
for performing operations in the Laplace transform; Laplace transform in research tasks
of the vibrations of a rod; and application of the Laplace transform in engineering technol-
ogy. Specific examples of solving differential equations are presented, applied to prob-
lems of mechanics and the theory of oscillations. The essence of Kondratenko’s method is
described, on the basis of which mathematical modeling of some technological operations
of mechanical engineering was carried out and features of dynamic phenomena during
the work of equipment and interaction of the tool with detail were revealed.
Chapter 2 investigates the history, nature, and importance of the Fourier series. This
chapter describes the periodic function, orthogonal function, Fourier series, Fourier
approximation, Dirichlet’s theorem, Riemann–Lebesgue lemma for Fourier series, dif-
ferentiation of Fourier series, convergence of the Fourier series of the functions, Fourier
transform, Fourier analysis with Fourier transform, and Gibbs phenomenon. Also, some
of the summability methods (Cesàro, Nörlund, Riesz, weighted mean, etc.), absolute sum-
mability methods, strong summability methods, necessary and sufficient conditions for
regularity of matrix of summability methods, uses of summability, norm, modulus of con-
tinuity, Lipschitz condition, various Lipschitz classes in trigonometric Fourier approxima-
tion, and importance of degree of approximation have been explained. The applications of
summability methods in approximation of the signals, the behavior of the Fourier series
of a piecewise smooth function (Gibbs phenomenon), Fourier series of signals of bounded
bandwidth, filtering by Fourier transforms, and applications of summability technique
and Fourier series have been described.
Chapter 3 describes the basics of soft computing and their applications. The key goal
of soft computing is to develop intelligent machines to provide solutions to real-world
problems, which are difficult to model mathematically.
Chapter 4 describes the study on solving transportation problems under a multi-objec-
tive environment. The main focus of this chapter is to introduce a new approach for solv-
ing multi-objective transportation problems in addition to the existing approaches such
as goal programming, fuzzy programming, and revised multi-choice goal programming.
In the proposed approach a procedure to obtain a Pareto-optimal solution of a multi-
objective transportation problem using the Vogel approximation method is incorporated.

vii
viii Preface

The merits and demerits of the approaches goal programming, fuzzy programming, and
revised multi-choice goal programming compared to our new approach to solving a multi-
objective transportation problem are presented.
Chapter 5 provides the study of simultaneous optimization of yield and viscosity of
the pulp cooking process using the dual-response surface methodology. The pulp cook-
ing process is an important step in the manufacturing of rayon grade pulp. The pulp is
the cellulose component of the wood. The cellulose is separated from other components
and impurities of wood by cooking the wood chips in a highly pressurized chamber fol-
lowed by multiple stages of washing and chemical treatments. The study is undertaken
to increase the pulp yield as far as possible without increasing the viscosity beyond the
specified upper limit.
Chapter 6 gives the concept of a time-dependent conflicting bifuzzy set (CBFS), and a
new procedure to construct the membership and nonmembership functions of the fuzzy
reliability function is proposed with the help of time-dependent CBFS. The concept of
triangular CBFS has been developed, and triangular CBFS is used to represent the failure
rate function of the system.
Chapter 7 focuses on the failure time data analysis based on the nonhomogeneous
Poisson process (NHPP) and discusses several statistical estimation methods for a periodic
replacement problem with minimal repair as the simplest application of life data analysis
with NHPP. Not only the parametric maximum likelihood estimation of the power law
process is applied, but also constrained nonparametric maximum likelihood estimation
(CNPMLE) and kernel-based estimation methods for estimating the cost-optimal periodic
replacement problem with the minimal repair, where single or multiple minimal repair
data are assumed.
Chapter 8 extends the available literature and discusses the important attribute “view-
count” of content dynamically. With the Internet emerging as a rapidly growing new mar-
ket, the netizens are also growing at a fast pace. Making use of this ideology, a modeling
framework whose utility has been highlighted through three models is proposed that
describes the growing Internet market size and repeat viewers. The models have been
validated on a YouTube entertainment video data set.
Chapter 9 analyzes dual-market modeling. Dual-market modeling is an increasingly
important concept in marketing, and in order to inculcate heterogeneity and the require-
ment of some specific characteristics for some technologies to be adopted differently in
different geographical locations, the authors intend to study this behavior through a math-
ematical framework that exhibits the dual-market phenomenon.
Chapter 10 presents a uniform methodology for three fundamental problems in data
analysis: identification/detection of atypical elements (outliers), clustering, and classifica-
tion. Such a unification facilitates understanding of the material and adapting it to the
individual needs and preferences of particular users. The investigated material is ready
to use, is practically parameter free, and does not require laborious exploration from the
researcher. This has been illustrated with a number of applications in the fields of engi-
neering, management, medicine and biology, as well as supplemented by a thematic bibli-
ography extending the issues presented.
Chapter 11 analyzes the statistical tolerance limits used today in both production and
research. It is often desirable to have statistical tolerance limits available for the distribu-
tions used to describe time-to-failure data in reliability problems. For example, one might
wish to know if at least a certain proportion of a manufactured product will operate for
at least, say, the warranty period. This question cannot usually be answered exactly, but
it may be possible to determine a lower tolerance limit, based on a preliminary random
Preface ix

sample, such that one can say with a certain confidence that at least a specified proportion
or more of the product will operate longer than the lower tolerance limit. Then reliability
statements can be made based on the lower tolerance limit, or, decisions can be reached by
comparing the tolerance limit to the warranty period.
Chapter 11 analyzes the lower tolerance limit, based on a preliminary random sam-
ple, such that one can say with a certain confidence that at least a specified proportion or
more of the product will operate longer than the lower tolerance limit, which presents a
new technique for constructing exact lower and upper tolerance limits on outcomes (for
example, on order statistics) in future samples. The technique used here emphasizes piv-
otal quantities relevant for obtaining tolerance factors and is applicable whenever the sta-
tistical problem is invariant under a group of transformations that acts transitively on the
parameter space. The proposed technique is based on a probability transformation and
pivotal quantity averaging. It is conceptually simple and easy to use. The discussion is
restricted to one-sided tolerance limits.
Chapter 12 deals with the design of torque-based PID controller and tuning its gains
with the help of two algorithms, namely, modified chaotic invasive weed optimization
(MCIWO) and modified chaotic invasive weed optimization-neural network (MCIWO-NN)
algorithms for the biped robot while walking on a staircase. An analytical method has
been developed to generate the gaits and design the torque-based PID controller. The
dynamics of the biped robot utilized in the said controller have been derived after utiliz-
ing the Lagrange–Euler formulation. Alongside, the authors utilized the MCIWO algo-
rithm to optimize the gains of the PID controller. Further, in the MCIWO-NN algorithm,
the MCIWO algorithm is used to evolve the architecture of the NN, which helped in pre-
dicting the gains of the PID controller in an adaptive manner. The developed algorithms
are tested in computer simulations and on a real biped robot.
In Chapter 13, intelligent predictive models for modeling fertility of Murrah bulls
using the various emerging machine learning (ML) algorithms, namely, neural networks
(NNs), support vector regression (SVR), decision trees (DTs), and random forests (RFs), and
a conventional linear model (LM) for regression have been described. These intelligent
ML models would provide decision support to organized dairy farms for selecting good
bulls. Hence, the ML models can be employed as a plausible alternative to linear regres-
sion models to assess more accurately the conception rate in Murrah breeding bulls at the
organized farms.
In Chapter 14, the computational study has been performed on the two-jet vectoring
through the Coanda surface, realizing the future concept of the vertical and short takeoff
and landing (V/STOL) of an aircraft for civil aviation purposes. The set of computations
has been performed from the incompressible flow regime to the incipient of the compress-
ible flow regime. This computational study aims to identify the design parameters through
the flow characteristics using the computational fluid dynamics technique.
Chapter 15 deals with the discussion on the collocation method which is a very well-
known numerical technique. Along with the description of the methodology adopted,
details are given for the used B-spline basis function in the collocation method. The prop-
erties of B-spline basis functions are discussed in this chapter with a description of the
types and degrees of B-spline basis functions.
In Chapter 16, utilizing Rayleigh’s approximation method, an attempt has been
made to study the reflection and refraction patterns in a corrugated interface sand-
wiched between an initially stressed fluid-saturated poroelastic half-space and a highly
anisotropic half-space. The highly anisotropic half-space is considered as triclinic.
Various two-dimensional plots have been drawn to show the effects of some affecting
x Preface

parameters such as initial stress parameter, corrugation amplitude, wavelength, and

frequency factor.
This book can be used as a support book for the final undergraduate engineering
course (for example, mechanical, mechatronics, industrial, computer science, information
technology, mathematics, etc.). Also, this book can serve as a valuable reference for aca-
demics, mechanical, mechatronics, computer science, information technology and indus-
trial engineers, environmental sciences as well as researchers in related subjects.

Mangey Ram
Dehradun, India

J. Paulo Davim
Aveiro, Portugal
Acknowledgments
The editors acknowledge CRC Press for this opportunity and professional support. Also,
we would like to thank all the chapter authors and reviewers for their availability for this
work.

xi
Editors
Mangey Ram received the PhD in mathematics and minor in computer science from
G. B. Pant University of Agriculture and Technology, Pantnagar, India, in 2008. He has
been a faculty member for around 10 years and has taught several core courses in pure
and applied mathematics at undergraduate, postgraduate, and doctorate levels. He is cur-
rently a professor at Graphic Era (Deemed to be University), Dehradun, India. Before
joining Graphic Era (Deemed to be University), he was a deputy manager (probation-
ary officer) with Syndicate Bank for a short period. He is editor-in-chief of International
Journal of Mathematical, Engineering and Management Sciences; and the guest editor and
member of the editorial boards of many journals. He is a regular reviewer for interna-
tional journals, including those published by the Institute of Electrical and Electronics
Engineers, Elsevier, Springer, Emerald, John Wiley, Taylor & Francis Group, and many
other publishers. He has published 125 research publications (published by Institute of
Electrical and Electronics Engineers, Springer, Emerald, World Scientific, among oth-
ers) and in many other national and international journals of repute and also presented
his works at national and international conferences. His fields of research are reliability
theory and applied mathematics. Ram is a senior member of the Institute of Electrical
and Electronics Engineers, member of the Operational Research Society of India, the
Society for Reliability Engineering, Quality and Operations Management in India, the
International Association of Engineers in Hong Kong, and the Emerald Literati Network
in the United Kingdom. He has been a member of the organizing committees of a num-
ber of international and national conferences, seminars, and workshops. He has been
conferred with the Young Scientist Award by the Uttarakhand State Council for Science
and Technology, Dehradun, in 2009. He has been awarded the Best Faculty Award in 2011
and recently the Research Excellence Award in 2015 for his significant contributions in
academics and research at Graphic Era (Deemed to be University).

J. Paulo Davim received his PhD in mechanical engineering in 1997, and MSc in mechani-
cal engineering (materials and manufacturing processes) in 1991, the Dipl-Ing engineer’s
degree (5 years) in mechanical engineering in 1986, from the University of Porto (FEUP),
the Aggregate title (Full Habilitation) from the University of Coimbra in 2005, and the
DSc from London Metropolitan University in 2013. He is Eur Ing by FEANI-Brussels and
senior chartered engineer by the Portuguese Institution of Engineers with a MBA and
Specialist title in engineering and industrial management. Currently, he is a professor at
the Department of Mechanical Engineering of the University of Aveiro, Portugal. He has
more than 30 years of teaching and research experience in manufacturing, materials and
mechanical engineering with special emphasis in machining and tribology. He also has
interest in management and industrial engineering and higher education for sustain-
ability and engineering education. He has guided large numbers of postdoc, PhD, and

xiii
xiv Editors

master’s degree students. He has received several scientific awards. He has worked as
the evaluator of projects for international research agencies as well as examiner of PhD
theses for many universities. He is the editor-in-chief of several international journals,
guest editor of journals, books editor, book series editor, and scientific advisor for many
international journals and conferences. Presently, he is an editorial board member of 25
international journals and acts as a reviewer for more than 80 prestigious Web of Science
journals. In addition, he has published as editor (and co-editor) more than 100 books
and as author (and co-author) more than 10 books, 70 book chapters, and 400 articles in
journals and conferences (more than 200 articles in journals indexed in Web of Science
core collection/h-index 41+/5000+ citations and SCOPUS/h-index 51+/7500+ citations).
Contributors
N. Aggrawal Dinesh Bisht
Department of Computer Science & Department of Mathematics
Information Technology Jaypee Institute of Information Technology
Jaypee Institute of Information Technology Noida, Uttar Pradesh, India
Noida, Uttar Pradesh, India
Atish Kumar Chakravarty
R. Aggarwal Computer Centre & Dairy Economics,
Department of Operational Research Statistics & Management Division
University of Delhi ICAR-National Dairy Research Institute
Delhi, India Karnal, Haryana, India

A. Anand Shshank Chaube

Department of Operational Research Department of Mathematics
University of Delhi University of Petroleum & Energy Studies
Delhi, India Dehradun, Uttarakhand, India

A. Arora K.K. Chowdhury

Department of Computer Science &
Information Technology
Jaypee Institute of Information Technology
Noida, Uttar Pradesh, India
Geeta Arora
Department of Mathematics
Lovely Professional University
Phagwara, Punjab, India
SQC & OR Unit
Indian Statistical Institute
Bangalore, Karnataka, India
Tadashi Dohi
Department of Information Engineering
Graduate School of Engineering
Hiroshima University
Higashihiroshima, Japan

G. Berzins M.S. Irshad

BVEF Research Institute Department of Operational Research
University of Latvia University of Delhi
Riga, Latvia Delhi, India

Neelima Bhengra Boby John

Department of Applied Mathematics SQC & OR Unit
Indian Institute of Technology (ISM) Indian Statistical Institute
Dhanbad, Jharkhand, India Bangalore, Karnataka, India

xv
xvi Contributors

Leonid Kondratenko A. Munjal

Department of Machine Science and Department of Mathematics
Machine Components National Institute of Technology
Moscow Aviation Institute (State National Kurukshetra
Research University) Kurukshetra, Haryana, India
Moscow, Russia
N.A. Nechval
Piotr Kulczycki BVEF Research Institute
Systems Research Institute University of Latvia
Polish Academy of Sciences Riga, Latvia
Warsaw, Poland
and K.N. Nechval
Division for Information Technology and Aviation Department
Systems Research Transport and Telecommunication
AGH University of Science and Technology Institute
Cracow, Poland Riga, Latvia

Anuj Kumar
Department of Mathematics
University of Petroleum & Energy
Studies
Dehradun, Uttarakhand, India
Gurupada Maity
Department of Applied Mathematics
with Oceanology and Computer
Programming
Vidyasagar University
Midnapore, West Bengal, India
Ravinder Malhotra
Computer Centre & Dairy Economics,
Statistics & Management Division
ICAR-National Dairy Research
Institute
Karnal, Haryana, India
Ravi Kumar Mandava
School of Mechanical Sciences
IIT Bhubaneswar
Bhubaneswar, Odisha, India
Lubov Mironova
Institute of Applied Technology
Russian University of Transport (MIIT)
Moscow, Russia
Sangeeta Pant
Department of Mathematics
University of Petroleum & Energy
Studies
Dehradun, Uttarakhand, India
Mangey Ram
Department of Mathematics, Computer
Science & Engineering
Graphic Era (Deemed to be University)
Dehradun, Uttarakhand, India
Sankar Kumar Roy
Department of Applied Mathematics
with Oceanology and Computer
Programming
Vidyasagar University
Midnapore, West Bengal, India
Yasuhiro Saito
Department of Maritime Safety
Technology
Japan Coast Guard Academy
Kure, Japan
Adesh Kumar Sharma
Computer Centre & Dairy Economics,
Statistics & Management Division
ICAR-National Dairy Research Institute
Karnal, Haryana, India
Contributors xvii

S. Sonker Maharshi Subhash

Department of Mathematics Department of Science and Methods in
National Institute of Technology Engineering
Kurukshetra University of Modena and Reggio Emilia
Kurukshetra, Haryana, India Reggio Emilia, Italy

O. Singh Michele Trancossi

Department of Operational Research Department of Science and Methods in
University of Delhi Engineering
Delhi, India University of Modena and Reggio Emilia
Reggio Emilia, Italy
S.B. Singh
Department of Mathematics, Statistics & Pandu R. Vundavilli
Computer Science School of Mechanical Sciences
G. B. Pant University of Agriculture & IIT Bhubaneswar
Technology Bhubaneswar, Odisha, India
Pantnagar, Uttarakhand, India

Pankaj Kumar Srivastava

Department of Mathematics
Jaypee Institute of Information Technology
Noida, Uttar Pradesh, India
chapter one

Application of the Laplace transform

in problems of studying the dynamic
properties of a material system and
in engineering technologies
Lubov Mironova
Russian University of Transport (MIIT)

Leonid Kondratenko
Moscow Aviation Institute (State National Research University)

Contents
1.1  esignation..............................................................................................................................2
D
1.2 Laplace transform and operations mapping......................................................................2
1.3 Linear substitutions................................................................................................................ 7
1.4 Differentiation and integration.............................................................................................9
1.5 Multiplication and curtailing.............................................................................................. 11
1.6 The image of a unit function and some other simple functions.................................... 13
1.7 Examples of solving some problems of mechanics......................................................... 18
1.8 Laplace transform in problems of studying oscillation of rods..................................... 23
1.9 Relationship between the velocities of the particles of an elementary volume
of a cylindrical rod with stresses........................................................................................ 24
1.10 An inertial disk rotating at the end of the rod................................................................. 25
1.11 Equations of torsional oscillations of a disk..................................................................... 26
1.12 Equations of longitudinal oscillations of a disk............................................................... 27
1.13 Application of the Laplace transform in engineering technology................................30
1.13.1 Method of studying oscillations of the velocities of motion and
stresses in mechanisms containing rod systems������������������������������������������������ 30
1.13.2 Features of functioning of a drive with a long force line.................................... 31
1.13.3 Investigation of dynamic features of the system in the technologies
of deephole machining������������������������������������������������������������������������������������������� 32
References........................................................................................................................................ 33

This chapter is written by engineers for engineers. The authors try to convey to the reader
the simplicity and accessibility of the methods in a concise form with the illustration of
the calculation schemes. For a more extensive study of the stated problems of mathemati-
cal modeling, at the end of the chapter are given the literature sources, from which the

1
2 Advanced Mathematical Techniques in Engineering Sciences

reader can obtain the necessary additional explanations. The list of authors includes well-
known scientists in the field of mathematics and mechanics – G. Doetsch, A.I. Lur’e, L.I.
Sedov, V.A. Ivanov, and B.K. Chemodanov. In compiling the theoretical material, we refer
to the authors mentioned. This chapter reflects the experience of lecturing on mathemati-
cal methods of modeling, as well as the personal participation of the authors in the work
in this technical field.
The material presented can be of interest to students, graduate students and other
specialists.

1.1 Designation
j — the imaginary unit; e—the base of natural logarithms;
α = σ + jω —the complex number;
Re—real part, Im—the imaginary part of the complex number;
s—a complex variable; s = x + jy, x = Re s, y = Im s;
L—the transformation (Laplace transform);
F(s)—function of complex variable s (Laplace representation);
f(t)—function of the real variable t (the original);
L[f(t)]—direct Laplace transform;
L −1[F(s)]—inverse Laplace transform; and
→—the sign of the correspondence of the transformation:
for the direct transformation −f(t) → F(s); for the inverse transformation −F(s) ← f(t).
In many formulas, fractional numbers are not represented by a standard record but by
a slash or by multiplication of the factor in the degree (n), irrational numbers are expressed
as a number in fractional power. For a correct understanding of these symbols, examples
are given:

a b a a 1
, a + b/c = a + , a/ ( b + c ) = , a ( bc + d ) =
−1
a/bc = , a1/2 = a , b −1/3 = 3 .
bc c b+c bc + d b

1.2 Laplace transform and operations mapping

The Laplace transform is a powerful mathematical method for solving differential, differ-
ence, and integral equations. By means of these equations, one can describe any physical
(technological) process and conduct mathematical modeling of the behavior of the object
and of the reaction of the environment under the influence of force or other factors, inves-
tigate the dynamic properties of the element of construction, and much more.
In many engineering problems, it is important to investigate a function f(t), where real
variable t is time. Such problems in mechanics relate to dynamic problems.
The simplest and most economical solution of such problems is possible with the help
of methods of the theory of operational calculus [1].
An important role in applied mathematical analysis is played by the Laplace integral

I=
∫ f (t ) e
0
− st
dt. (1.1)
Chapter one: Application of the Laplace transform in problems 3

Here, s is a complex variable; s = x + jy; t > 0.

To calculate the Laplace integral, the definition and behavior of the function f(t) for a
negative value of the argument t < 0 are immaterial. Therefore, we consider a subclass of
piecewise continuous functions f(t) of the real variable t defined for t > 0 and assumed to
be zero for t < 0 (Figure 1.1).
This class of functions is characterized by a certain order of growth, such that for any
t > 0 the module f(t) grows more slowly than some exponential function [1].
Expression (1.1) in the operational calculus and its applications is applied in the fol-
lowing form:
∞

F( s) =
∫ f (t)e
0
− st
dt . (1.2)

Here, the function F(s) is a function of the complex variable s = x + jy.

In the new expression (1.2), the function of the complex variable s is put in correspon-
dence with the function of the real variable t. Such a correspondence is called the Laplace
transform. Symbolically, the Laplace transform is written in form
∞

L  f (t)  = F( s) =
∫ f (t)e
0
− st
dt . (1.3)

The record L[f(t)] means L-transformation. The Laplace transform connects the single-
valued function F(s) of the complex variable s (image) with the corresponding function f(t)
of the real variable t (the original). A brief description of the essence of the Laplace trans-
form and the correspondence table of operations can be found in Ref. [2].
As can be seen from (1.2), this transformation consists of multiplying the function f(t)
by the exponential function e−s and integrating the product of these functions with respect
to the argument t in the range from 0 to ∞.
From the image of F(s), if it exists, one can always find the original f(t). Such a transi-
tion is called the inverse Laplace transform, symbolically denoted by L −1, and corresponds to
x + j∞
1
f (t) = L [ F( s)] =
−1
2π ∫ F(s)e
x − j∞
st
ds, t > 0. (1.4)

f (t1 – 0) f (t1 + 0)

f (0)

t
t1

Figure 1.1 A piecewise-continuous function: t1 is a point of discontinuity of the first kind;

f ( +0 ) = limt→+0 f (t); f (−0) = 0; f (t1 + 0) − f (t1 − 0) – function jump f (t).
4 Advanced Mathematical Techniques in Engineering Sciences

The right-hand side of Equation (1.4) is called the inverse of the Laplace integral and is a com-
plex integral.
If relation (1.4) is rewritten in the form
+∞

∫e
−∞
jyt
( x + jy ) dy = 2π e − xt f (t ) for t > 0;

+∞

∫e
−∞
jyt
( x + jy ) dy = 0 for t < 0, (1.5)

then the formulas (1.2) and (1.5) have a physical meaning. For a constant value of x in the
complex variable s = x + jy, the function F(x + jy) is the spectral density of the damped time
function e−stf(t) for which the variable y is the circular frequency. Such a change in the vari-
able s in the complex plane corresponds to the displacement of the point along the vertical
line with the abscissa x (Figure 1.2).
From the mathematical point of view, multiplying the function f(t) by e−st makes the
improper integral of the right-hand side of expression (1.2) a convergent in the half-plane
Re s > x0 (Figure 1.3).
The function f(t) can be an original only if the following conditions are satisfied:

jy

Re s > x0

х0
х
O

Figure 1.2 Changing the complex variable.

jy

s
y

х
O
х

Figure 1.3 The domain of convergence of the Laplace integral.

Chapter one: Application of the Laplace transform in problems 5

1. The function f(t) is continuous for all values t ≥ 0. Continuity can be violated only at
points of discontinuity of the first kind. The number of these points must be finite in
any interval of limited length (Figure 1.1).
2. The function f(t) = 0 for the values t < 0.
3. The function f(t) has a limited order of increasing (i.e., one can find constant numbers).
4. M > 0 and x0 ≥ 0 such that

f ( t ) < Me x0t , t > 0.

Here, x0 is the exponent of the growth of the function f(t).

The set of all f(t) is called the space of originals, and the set of all F(s) is the image
space.
An important property of the Laplace transform is the following: the images obtained
as a result of the L-transformation are analytic functions. Such functions (as complex func-
tions) can be differentiated as many times as desired.
The true meaning of the Laplace transform is that this transformation has the char-
acter of a single-valued mapping of the function from the space of originals in the image
space, in which the operations performed on the image function are much simpler and
more obvious. The transition from the image to the original makes it possible to obtain the
desired solutions in a simpler way.
By virtue of the brevity of the following presentation, we give without proofs theo-
rems characterizing the important properties of the Laplace transform. A complete exposi-
tion and proofs of the theorems are given in Refs. [1,3,4].

Theorem 1.1: If the function f(t) is an original, then this function is Laplace trans-
formed and the image of the given function F(s) is defined in the half-plane Re s > x0,
where x0 is the growth index of the function f(t).
Under the condition Re s > x0, the integral (1.2) is an absolutely convergent inte-
gral. The number x0 is called the abscissa of absolute convergence of the integral (1.2).
Theorem 1.2: The image F(s) of the original f(t) in the half-plane, for which Re s > x0,
where x0 is the growth index of the original, is an analytic function.
The continuity of the function F(s) follows from the proof of Theorem 1.1.
This important property makes it possible to use powerful methods of the theory
of functions of a complex variable in calculations, because in the practical applica-
tion of Laplace, calculations are performed not over given functions, but over their
images.
The analytic expression of the original through the image is formulated by
Theorem 1.3.
Theorem 1.3: The original f(t) at points of continuity is defined by

x + j∞
1
f (t) =
2π ∫ F(s)e
x − j∞
st
ds, (1.6)

where F(s) is the Laplace representation of the original f(t), and the integral on the
right-hand side of this equation is understood in the sense of the principal value
6 Advanced Mathematical Techniques in Engineering Sciences

jy

ds
Re s > x0

х0
х
O

Figure 1.4 The domain of inversion of the Laplace integral: ds = jdy.

x + j∞ x + jy

∫
x − j∞
F( s)e st ds = lim y→∞
∫ F(s)e
x − jy
st
ds,

and this is taken along a straight line parallel to the imaginary axis and located in the
half-plane Re s > x0 (Figure 1.4).
Formula (1.6) is called the Laplace inversion formula and establishes a connection
between the image of F(s) and the single-valued corresponding original f(t). The pro-
cess of obtaining the original from a given image is written by the expression (1.4).
The formula (1.6) defines the original only at the points of its continuity. However,
for the piecewise-continuous functions f(t), illustrated in Figure 1.1, the limit of the
right-hand side of (1.6) at the points of discontinuity of the first kind exists and is
defined by

x + j∞
1 1
lim y→∞
2π j ∫ F(s)e
x − j∞
st
ds =
2
 f ( t + 0 ) + f ( t − 0 )  .

From this follows another important property—the single value of the Laplace transform.
The original always corresponds to a single image, since the values of the origi-
nal at points of discontinuity do not change the view of the image. At the same time,
the same image can be associated with a set of originals, the values of which differ
from each other only at points of discontinuity [4].
Corollary of Theorem 1.3: If the original is a differentiable function everywhere in
the interval 0 < t < ∞, then the original with respect to the given image is uniquely
determined.
It should be noted that not all analytical functions can be images. In particular,
periodic functions of the form eαs, cos s, sin s, are not images, and not all functions
2
can be originals (1/t , tg ω t , e t ). The proof of the theorem, which determines sufficient
conditions when the function F(s) is an image, is find in Refs. [4,5].
The Laplace transform is the result of the extension of the Fourier transform to
functions that satisfy the Dirichlet conditions in the interval 0 < t < ∞ but do not sat-
isfy the condition of absolute integrability in this interval. The connection between
the Fourier transform and the Laplace transform is clearly presented in Ref. [3]. The
Fourier and Laplace transforms are widely used in the theory of automatic regulation.
Chapter one: Application of the Laplace transform in problems 7

The next important property of the Laplace transform is the linearity of the trans-
formation, which is formulated by a theorem that establishes the “original-image”
correspondence.
Theorem 1.4: If the functions f1(t), f2(t), …, fn(t) are originals, and the images of these
functions are, respectively, F1(s), F2(s), …, Fn(s), and if λ1, λ2, …, λn are quantities that do
not depend on t and s, then the following equalities hold:

 n  n

L
 k = 1
∑λ k f k (t)  =

∑ λ F (s);
k =1
k k (1.7)

 n  n

L  −1

 k = 1
∑
λ k Fk ( s)  =

∑ λ f (t).
k =1
k k (1.8)

The linearity property allows, in the practical application of the Laplace trans-
form, performance of calculations not on the given functions, but on their images,
applying the table of correspondences between the originals and the images. In this
case, you need to know not only the images of individual functions, but also the
rules for displaying operations performed on such functions. Therefore, following
we formulate other properties of transformation (differentiability, integrability, etc.)
in the form of rules, and we call such rules later when solving some mathematical
problems.

1.3 Linear substitutions
We give the rules for linear transformation of an argument in the original or image. For
simplicity of clarity, instead of the symbolic designation of the transformation, we intro-
duce the arrows indicating the direct and inverse Laplace transformations.
Rule I. Theorem 1.5: Similarity theorem. Multiplying the argument of the original
(image) by a certain positive number results in the division of the image (the original)
and argument of the image (the original) into the same positive number

1  s 1  t
f ( at ) → F   , F ( as ) ← f   a > 0. (1.9)
a  a a  a

This operation characterizes the change in the scale of the independent variable.
Rule II. Theorem 1.6: First displacement theorem (the lag theorem). If the function f(t) is
an original and F(s) is its image, then the image of the displaced original f(t − a), where
a is a real number, is determined by the expression

f (t − a) → e − as F( s); a > 0. (1.10)

For the inverse transformation is valid

e − as F( s) = 0, for t < a ;
8 Advanced Mathematical Techniques in Engineering Sciences

e − as F( s) ← f (t), for t > a. (1.11)

Since t < a, the argument t − a is negative, then the function f(t − a) is equal to zero.
The graph of this function is obtained from the graph of the function f(t) by shifting
its graph to the right by a distance a (Figure 1.5a, b).
The displacement theorem has a wide application in the theory of automatic reg-
ulation, as well as in the study of processes described by piecewise-continuous and
periodic functions.
Rule III. Theorem 1.7: Second bias theorem (the bias theorem). If the function f(t) is the
original and F(s) is the image, then the image of the displaced original f(t + a), where
a is a real number, is determined by the expression

 a

f (t + a) → e  F( s) −

as
∫
0
e − st f (t)dt  ; a > 0.

(1.12)

The essence of this theorem is that the image of F(s) cannot be linearly transformed
into the original of the function f(t + a), since the right-hand side of Equation (1.12)
has a finite Laplace integral. Its calculation is carried out in the interval of variation
of the real variable 0 ≤ t < a.
This rule is the opposite of the second rule. The graph of the function f(t) is
shifted to the left by a distance a (Figure 1.5a, c).
The bias theorem determines the ratio of the image and the original in the case
when the complex variable is displaced by a [1]:
t

F ( s + a) ← e − at
∫
f (t) + a e − at f (t) dt .
0
(1.13)

(a)
f (t)

t
O

(b) (c)

f (t – a)
f (t + a)

t t
O O
а
а

Figure 1.5 Offset function to the right and left.

Chapter one: Application of the Laplace transform in problems 9

Rule III plays an important role in solving difference equations [3].

Rule IV. Theorem 1.8: Damping theorem. If the function f(t) is the original and F(s) is
the image, and if α is any complex number, then we can write

eα t f (t) → F( s − α ) (1.14)

or

e −α t f (t) → F( s + α ). (1.15)

It follows that if the correspondence f(t) → F(s) holds in the half-plane.

Re s = x > x0, then the correspondence (1.14) is meaningful for Re (s + α) > x0, i.e.,
Re s > x0 - Re α. The actual attenuation of the original occurs only if α is a positive
real number.

1.4 Differentiation and integration

The following theorems establish two important properties of the Laplace transform.
Theorem 1.9: The differentiation theorem for the original.
If the function f(t) and its derivative are f′(t) originals and F(s) is the image of the
original f(t), then is justly the equality

L  f ′ ( t )  = sF ( s ) − f ( +0 ) , where f ( +0 ) = limt→0 f ( t ) . (1.16)

If we set the initial value f (+0) = 0, then from formula (1.16) we obtain

L  f ′(t)  = sF( s).

Hence, we formulate the following rule.

Rule V. The operation of differentiating the original corresponds to the operation of
multiplying the image of this original by the complex number s.

f ′(t) → sF( s). (1.17)

If the derivatives of higher orders f (2)(t), f (3)(t), …, f (n)(t) are originals, then the following
relations hold:

f ( 2 ) (t) → s2 F( s) − f (+0) − f ′(+0);

f (3) (t) → s3 F( s) − f (+0)s2 − f ′(+0)s − f (2) (+0);

and

f ( n)
(t ) → s F ( s) −
n
∑s
k +1
n− k
f ( k − 1) ( +0 ). (1.18)
10 Advanced Mathematical Techniques in Engineering Sciences

The essence of Rule V is as follows. The differentiation, which in the origin space
is a transcendent process [3], is replaced in the image space by multiplying the image
by the degree of argument s with the simultaneous addition of the polynomial whose
coefficients are the initial values of the original.
Rule V assumes that the derivative of the highest order f (n) (t) exists at each point t > 0
and has an image. This rule is especially valuable in solving differential equations.
In the operational calculus, instead of the Laplace integral (1.3), we prefer to
­consider the function

∫
F( s) = s L[ f (t)]; F( s) = s e − st f (t) dt
0
(1.19)

or
∞
F( s)
s
=
∫e
0
− st
f (t) dt. (1.20)

Taking into account (1.19), we give the most important ratio of operational calculus

 f ′(0) 
f ′(t) → s  F( s) − f (0)  ; f ′′(t) → s 2  F( s) − f (0) − ;
 s 

 f ′(0) f ( n− 1) (0) 
f ( n) (t) → sn  F( s) − f (0) − −  − ( n− 1)  . (1.21)
 s s 

There are no contradictions between the formulas for differentiating the original
(1.18) and the expressions (1.21). According to the rule for calculating the integral,
these expressions differ only in the integration constants. Only in (1.18), these con-
stants are real, and in (1.21) are only complex quantities.
The essence of the function (1.19) lies in the fact that in transformations we work
in image space only with analytic functions and their initial values. This important
technique is widely used in mechanics and other technical applications. Then, using
a concrete example, we show the advantages of applying formulas (1.21).
Rule VI. Theorem 1.10: Differentiation theorem for an image.
If the function f(t) is an original and F(s) is an image, then is justly the equality

d
L tf (t)  = − F( s). (1.22)
ds

Since the image of F(s) is always an analytic function and possesses all derivatives, on
the basis of (1.22) one can obtain derivatives of any order.
Thus, the operation of image differentiation with respect to s corresponds to the
­operation of multiplying the original by an independent variable t taken with the
opposite sign:

−tf (t) → F ′( s); t 2 f (t) → F ( 2 ) ( s); (−1)n t n f (t) → F ( n) ( s). (1.23)

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 6 Of one of Hennen's cases it is reported that “the life of the patient and the perfect
healing of the wound were terminated on the same day.”

7 Morrison seventy years ago wrote: “Wounds from which there is a copious
discharge of bland pus are seldom or never followed by this disease;” and as a rule
this is true.

The nerves in and about the injured area have often been found
reddened and swollen, their neuroglia thickened and indurated, and
blood extravasated at various points. At times, even when to the
naked eye healthy, microscopic examination has shown one or a few
of the constituent bundles inflamed. But repeatedly the most
thorough search has failed to find any departure from the normal
state, and the same appearances of congestion and inflammation
are not seldom observed when there has been no tetanic
complication. In an interesting case reported by Michaud the sciatic
in the uninjured limb presented the same neuritic lesions as that of
the wounded side.

In the cord and the medulla vascular congestion has been the
condition most generally seen, associated not infrequently with
hemorrhages and serous effusions—a condition occasionally absent,
and when present due, it is probable, in great measure, perhaps
wholly, to the muscular spasms, or consequent in part upon post-
mortem gravitation of the fluids. Increase in the amount of the
connective tissue of the white columns of the cord (thought by
Rokitansky to be the essential lesion of the disease); disseminated
patches of granular and fluid disintegration (to which Lockhart Clarke
called attention in 1864); atrophy of the cells, especially those of the
posterior gray commissure; nuclear proliferation; changes in the
color, form, and chemical reaction of the ganglion-cells; dilatation
and aneurismal swellings of the vessels, with development of
granulation-masses in their walls; and changes in the sympathetic
ganglia,—such have been the reported lesions. But each and every
one has at times been absent—at times been discovered in the
bodies of those dead of other diseases. Some of the changes have
without doubt been produced after death; some perhaps have been
but errors of observation.

The muscles have been found healthy in appearance and

constitution; discolored, softened, and the seat of blood-
extravasations large and small; undergoing the vitreous
degeneration; and ruptured, the laceration affecting a few fibres or
the entire thickness of one or more muscles, as the rectus
abdominis, the muscles of the neck, those in the vertebral gutter, and
even the heart. The rigor mortis appears at once or very soon, thus
confirming Brown-Séquard's observation, that cadaveric rigidity is
“quick in coming on and quick in passing off in direct proportion to
the amount of long-continued violent action which preceded death.”
The visceral congestions that have been observed cannot be
regarded as in any way peculiar, but as due simply to the muscular
spasms and the mode of dying.

It is probably by chemical and microscopical examinations of the

blood, and, much more, the solids and fluids of the damaged part or
the secretions of the skin in the non-traumatic cases, that the cause
of this obscure affection is to be discovered, and not from study of
the nerves, the cord, and the brain; which study up to the present
time has only shown that “tetanus has no morbid anatomy, except
perhaps its traumatic cause and the asphyxial congestions resulting
from it.”

SYMPTOMS.—Following the receipt of a wound, tetanus may be

developed quickly or only after many days, cases of more or less
credibility being on record of immediate appearance, and of an
elapsed interval of one, two, three, even seven months (in a case
occurring during our late war). Doubt, however, may very properly be
entertained as to the true tetanic character of some at least of these
very long-delayed cases, or of their dependence upon the previous
traumatism. The very common belief that after the lapse of three
weeks no fear of the disease need be entertained is unquestionably
an erroneous one, but the danger certainly is slight when the
wounded person has escaped for twenty-two entire days. In by far
the larger proportion of cases the outbreak occurs between the fifth
and fifteenth days after injury—in about two-thirds, according to
Yandell's, or about four-fifths, according to Joseph Jones's and Otis's
statistics.

Not infrequently for a day or two before any distinct evidences of the
disease are manifested there is prodromal malaise, associated at
times, but by no means constantly, with unusual sensitiveness, or
even positive pain, in the wound and slight muscular twitching in its
vicinity. In the larger number of cases the first symptoms noticed are
stiffness about the jaw, more or less difficulty in opening the mouth,
and perhaps slight interference with deglutition, the patient feeling as
if he had taken cold; such symptoms often appearing early in the
morning after waking from the night's sleep. With more or less
rapidity well-marked trismus comes on, the jaws being locked, the
corners of the mouth retracted, and the lips either firmly closed or
separated so as to uncover the teeth, producing the peculiar grin
long known as the risus sardonicus.

In rare cases it is the depressors, and not the elevators, of the lower
jaw that are in a state of contraction, the mouth consequently being
kept wide open. The forehead is wrinkled, the eyes staring, the nose
pinched, and not seldom there is the facial expression of old age.
The voice is altered and swallowing is difficult. Occasionally the
spasms of the muscles of deglutition are so intense as to be the
principal tetanic symptom, such dysphagic or hydrophobic (Rose)
tetanus very generally proving fatal. In a few cases, after wounds of
the face and head, these violent spasms have been found
associated with facial paralysis, almost always, if not always, on the
injured side; such paralysis having been present in at least one case
(Bond's) in which throat-spasm was wanting, the wound being in the
temporo-parietal region. Often there is early felt in greater or less
intensity pain, as from pressure, in the epigastrium, piercing through
to the back—a symptom by some regarded as pathognomonic, and
due without doubt to contraction of the diaphragm.
From the region of the jaw the disease passes on to successively
attack the muscles of the neck, the back, the abdomen, the chest,
the lower, and, last of all, the upper, extremities, those of the forearm
long after those of the arms. The muscles of the fingers, of the
tongue, and those of the eyeball are very late if at all affected, the
tongue probably never being tonically contracted. The anterior
abdominal wall is broadened, depressed, and hard. In the fully-
developed acute cases the whole body is rigid, remaining perfectly
straight (orthotonos), arched backward (opisthotonos), forward
(emprosthotonos), or laterally (pleurosthotonos), according as the
muscular tension is balanced or greater on one side than another.
The action of the extensors being usually the more powerful,
backward bending (opisthotonos) to a greater or less extent is the
ordinary condition; but only in rare and extreme cases is the
contraction such as to curve the body like a bow and keep it
supported upon the occiput and heels. Frequently the bending is not
specially noticeable except in the neck. Emprosthotonos is rare, and
pleurosthotonos has been so seldom observed that its very
existence has been denied. Occasionally, in well-marked cases of
opisthotonos, there is some associated lateral arching, due rather to
voluntary efforts on the part of the patient (for the purpose of
obtaining relief) than to tetanic contraction. Larrey's opinion that the
location of the wound (behind, in front, or on the side) determined
the direction of the curving has been proved to be incorrect. Except
in a small proportion of cases to the persistent tonic spasm8 there is
added convulsive seizures of the affected muscles, developed upon
any, even the slightest, peripheral excitation of the reflex irritability,
as by a movement, a touch, a draft of air, a bright light, a sudden
noise, an attempt at swallowing, etc. The frequency of these clonic
exacerbations and their intensity vary much, being severer and
coming on closer together in the grave acute cases and in the later
stages of those terminating fatally. They may occur only once in
several hours or four, five, or more times in a single hour, each
spasm lasting from but a few seconds to a minute or two. During its
continuance the suffering is intense, both from the pain of the
contraction and the experienced sense of suffocation. Between the
paroxysms there is usually but little pain, the sensation being rather
one of tension or pressure. Occasionally cessation of spasms and
complete relaxation of all muscular contraction suddenly take place
six, eight, or twelve hours before death, the patient quickly passing
into a state of collapse.
8 This is not, in reality, a state of uninterrupted spasm, but one of very numerous,
quickly-repeated muscular contractions, as many even as six hundred and sixty per
minute (Richelot).

Throughout the whole course of the disease the mind remains clear,9
except in the later stages of a few cases; and then the existing
delirium or coma is often, it is probable, an effect of the treatment
that has been employed. Except in the more chronic cases the
patient is generally unable to sleep, and even when fortunate
enough to do so the tonic spasm may not relax. In other than the
mildest attacks there is usually noticed a marked increase, local or
general, of the perspiration; such sweating being a much more
prominent symptom of the disease as met with in tropical than in
temperate regions.
9 “The brain alone in this general invasion has appeared to us to constantly preserve
the integrity of its functions down to the very last moment of existence, so that the
unfortunate subject of this disease is, as it were, an eye-witness of his own death”
(Larrey).

The pulse, which is normal in the earlier stages, may later be but
little increased in frequency (except during the exacerbations, when,
small and compressible, its beats may run up to 140, 160, or even
180 per minute), or it may become progressively feebler and more
rapid as the case advances toward the fatal termination. The
irregularity often noticed during the convulsive seizures is doubtless
owing to the muscular contractions so compressing the vessels as to
hinder the passage of the blood through them. That the heart itself is
not tetanically contracted would seem to be proved by its regular
quiet action during anæsthesia.

The body-heat varies greatly in different cases, the temperature

being oftentimes normal, or even subnormal, until toward the very
last. Not infrequently, even in severe and fatal cases, it is not
increased more than two or three degrees, and quite rarely, except
just before death, does it rise much above 103° F. Exceptionally, very
high temperatures have been observed; I have myself seen one of
108° F. an hour before death. Prévost had a patient whose axillary
temperature was 110¾° F. Lehmann reports a heat of 111.9° F. just
before death, and in one of Wunderlich's cases the temperature (that
three hours earlier was 103.5° F.) fifteen minutes before death was
110.1° F., and at death 112.5° F., with a further post-mortem rise of
more than a degree (113⅔° F.)—a phenomenon that has been
observed in a number of cases. This increased temperature of
tetanus is not of inflammatory origin (except as a part of it, at times,
may be due to intercurrent affections, especially a broncho-
pneumonia), but depends doubtless upon a combination of causes,
among them the violent muscular spasms, and, more particularly, the
disturbance of the regulating heat-centre or centres from the
alterations of their blood-supply in quantity and quality.

The bowels are usually constipated, because of the little food taken,
the profuse sweating, the tonic spasms of the abdominal muscles,
and the contraction of the external sphincter and the levator ani, the
muscular coat of the bowel, like all the other involuntary muscles,
remaining unaffected.

Micturition, generally infrequent because of scanty secretion, may or

may not be disturbed. In many cases it is true, as written by
Aretæus, "the urine is retained so as to induce strong dysuria, or
passes spontaneously from contraction of the bladder,” though it is
the external muscles, and not the bladder itself, the contraction of
which produces the retention or the discharge; which latter is of rare
occurrence.

DIAGNOSIS.—When fully developed, with all its characteristic

symptoms present, tetanus cannot, or at least ought not to, be
mistaken for anything else; yet a study of reported cases will show
that errors of diagnosis have been made, and because of such
errors various methods of treatment have been given undue credit
as curative measures. Wound-spasms, clonic in character, of
different degrees of severity, beginning in and confined to the
muscles of the injured part or limb (even of the lower segment of the
upper extremity), have not seldom been regarded as tetanic, which
they certainly are not; and recovery having taken place, it has been
attributed to the adopted treatment, operative or therapeutic. The
comparatively few cases in which, primarily located in the vicinity of
the wound, these traumatic spasms have become generalized in
strict accordance with Pflüger's laws, or, much more rarely, passing
over the intervening parts of the body, have seized upon the muscles
of the jaw and neck, may perhaps, for want of accurate knowledge of
the essential nature of tetanus, be regarded as a variety of the
disease; but it is much to be regretted that observers and reporters
have not clearly separated them from the cases of true tetanus (or
the commonly met-with variety of tetanus) in which the first or first
important symptoms are always in connection with the muscles
whose nerves take origin in the medulla oblongata, no matter where
the wound may be located or whether there is any wound at all. Not
a few of the idiopathic cases may justly be regarded as of tetany,
that “little tetanus” in which the spasms always proceed from the
periphery toward the centre; are especially likely to affect the
forearms and the fingers, forming in their contractions the obstetrical
hand; are followed by periods of complete relaxation; can be brought
on by compression of the main artery or nerve of the limb, or by light
tapping of the affected area; may cause a rigid state of the trunkal
muscles or even well-marked opisthotonos; are associated with
impairment or paralysis of sensation; may last for a few minutes or
for hours; and sooner or later spontaneously cease, a fatal
termination of the affection being exceedingly rare.

Hysterical spasms may strongly simulate those of tetanus, and such

attacks have without doubt been wrongly diagnosticated, the cases
going to swell the number of those successfully treated by one
remedy or another. They ought, however, to be readily recognized if
due consideration be had of the age and character of the patients,
the history of the attack, and the order and nature of the symptoms
themselves, especially their frequent limitation to one member
(preferably a leg), the absence of consciousness during the attacks,
the long and uninterrupted rest at night, their more or less often and
prolonged complete intermissions.

Cerebro-spinal meningitis, because of the developed stiffness of the

neck and retraction of the head, the orthotonos, or even well-marked
opisthotonos, the epigastric pressure-pain, the occasional trismus,
and rigidity with reflex convulsive movements of the muscles of the
extremities, may, and doubtless has been, mistaken for tetanus; but
its generally epidemic prevalence, the headache, the cutaneous
hyperæsthesia, the temperature, and the other well-known
symptoms of the disease ought to suffice for its ready determination.

Strychnia-poisoning has many symptoms in common with tetanus,

but there is an absence of the wound which is generally associated
with the latter affection, a much more rapid development of severe
convulsions, and a quickly-appearing opisthotonos. The spasms
from the commencement affect the extremities, producing early
contractions of the muscles of the hands and feet, and only later
those of the jaw. Complete intermissions of greater or less length
usually occur, and either death or marked amelioration of pain and
spasm follows in a comparatively short time.

Hydrophobia, the dysphagic symptoms of which are like those at

times observed in tetanus, has its peculiar wound of origin and
protracted period of incubation, its absence of trismus or general
tonic muscular contractions, its usual dread of water and inability to
swallow fluids, its attendant restlessness, and its frequently-
observed delirium, the entire aggregation of symptoms being
characteristic of itself and nothing else except the simulating nervous
affections occasionally developed in individuals bitten by rabid or
supposed rabid animals.

PROGNOSIS.—As declared by Hippocrates, “the spasm that comes on

after the receipt of a wound is a frequent cause of death.” Violent
acute cases, developing early, are excessively dangerous; and there
is much truth in Poland's declaration that “there is scarcely a well-
authenticated instance of recovery on record.” Taking all the
traumatic cases together as met with in military and civil hospitals,
the death-rate may safely be placed at not less than 80 per cent. Of
1332 cases reported from the wars of the last thirty years, and
occurring in six large hospitals during the last twenty years, 1060
proved fatal—i.e. 79.6 per cent.10
10 Crimean war, 23—21, 91 per cent.; Confederate army, (Sorrel), 66—60, 91 per
cent.; U. S. army, 505—451, 89.3 per cent.; Italian war (Demme and Chenu), 176—
162, 91 per cent.; Franco-German war (Poncet), 316—181, 57.28 per cent. (omitting
Richter's 224 cases with only 107 deaths, the mortality of the remaining 92 cases (74)
was 80 per cent.); St. Thomas's Hospital, 43—24, 55.8 per cent.; St. George's
Hospital, 30—21, 70 per cent.; St. Bartholomew's Hospital, 63—47, 74.6 per cent.;
Guy's Hospital, 60—51, 85 per cent.; Pennsylvania Hospital, 26—20, 76.9 per cent.;
Boston City Hospital, 24—22, 91.6 per cent. The mortality-rate at Guy's (85 per cent.)
is almost the same as that given by Poland for the period from 1825 to 1858 (86.1 per
cent.).

As met with in private practice, under favorable hygienic

surroundings, a decidedly larger percentage of recoveries probably
takes place—how much larger cannot be even approximately
determined, since, as a rule, only those cases which get well are
reported, but few patients come under the care of any single
observer, and the chances of error in diagnosis are much greater
than in a large general hospital. The mortality rate of the idiopathic
cases is very much lower (not exceeding perhaps 25 or 30 per
cent.), localized trismus being “never mortal, though it may last for a
number of weeks” (Poncet). That recovery should take place much
more frequently in cases of this variety than in those associated with
wounds might be anticipated, since, as a rule, they are more chronic
in their course; the attacks are less frequent; if generalized, the
spasms do not involve all the muscles at once, but by progressive
seizures and relaxations; and they less often and less severely affect
the muscles of respiration. The earlier the disease shows itself after
the receipt of a wound (other things being equal), the stronger the
likelihood of a fatal termination; and, for obvious reasons, the more
powerful, more general, and more quickly repeated the spasms, the
greater is the danger. The larger part of the deaths occur within the
first week, a majority by the fifth day; all experience tends to show
that there was much truth in the Hippocratic observation, that “such
persons as are seized with tetanus die within four days, or if they
pass these they recover.” From the end of the first week on, the
chances of recovery rapidly increase day by day, and after the
second week there is but little danger of a fatal termination, though
death may take place (from exhaustion usually) after the lapse of
several weeks, six or more.11 I have myself seen it occur on the
thirty-seventh day.
11 Of the 358 cases reported in the Medical and Surgical History of the War of the
Rebellion, the duration of which was known, 64.8 per cent. died within five, and 83.5
per cent. within ten days. Of 327 cases reported by Poland and Hulke, 56 per cent.
died within the earlier, and 83.5 per cent. the later, period. Of Richter's cases, 76.6 per
cent. died within five days. Of 170 cases tabulated by Yandell, 53 per cent. died within
the first four days, and 77 per cent. within nine days.

Recovery is usually slow. Even in the non-traumatic cases the period

of convalescence very seldom is less than two months, and, as has
been truly said, “it is a very mild case that the patient is well of in
thirty days.” More or less stiffness of the muscles usually continues
for many weeks; in one case (Currie's) “his features retained the
indelible impression of the disease;” and Copland reports having
seen a man who had had tetanus nine years before, whose jaws
were still permanently locked. Relapses may easily be brought on by
exposure or slight imprudences, and such secondary attacks not
infrequently prove fatal. The earlier and more severely dysphagic
symptoms are manifested, the more grave the prognosis; and the
sooner disturbances of respiration are shown, the speedier the
death, since spasm of the respiratory muscles, in the words of
Aretæus, “readily frees the patient from life.” Generally stated, “the
more powerful the contractions, the greater the irritation and the
danger;” and the longer the delay of involvement of the respiratory
muscles, the more favorable the prognosis. The occurrence of
strabismus is of grave import (Wunderlich), as might be expected,
since only in very severe cases or in the later hours are the deep
muscles of the eye affected by spasm. The manifestation of delirium
(which is rare, and sometimes, if not generally, due to over-
medication) indicates with almost absolute certainty a speedy death.

The pulse-rate and temperature, especially the latter, afford

prognostic indications of value.

A rapid pulse is an unfavorable symptom; and if at the same time it is

feeble and irregular, the probabilities of an early death are very
great.12 Though, as has already been stated, the temperature often
varies but slightly from the normal, even in acute and rapidly fatal
cases, yet when the thermometer does not indicate a body-heat of
over 100° F. the prognosis is unquestionably more favorable than
when it is two or more degrees higher; and there is certainly much
truth in the opinion (Arloing and Tripier) that as long as the rectal
temperature is not above 1002/5° F. (38° C.) the prognosis is
favorable; whereas when it rises the prognosis at once becomes
much more grave, few patients recovering in whom it reaches 103°
F. Oscillations of temperature are of no prognostic value, good or
bad.
12 Few at the present time share Parry's belief, that “if in an adult the pulse by the
fourth or fifth day does not reach 100 or perhaps 110 beats in a minute the patient
almost always recovers,” and “if, on the other hand, the pulse on the first day is 120 or
more in a minute, few instances will be found in which he will not die.”

Death usually occurs suddenly, from spasm of the external

respiratory muscles or of those of the larynx, but it may be
consequent upon a slow strangulation, upon exhaustion (as it
frequently is in the chronic cases), or even upon heart rupture, as in
a patient of Dujardin-Beaumetz.

How far the age of the patient affects the prognosis cannot be very
definitely stated. The prevalent opinion (entertained as long ago as
the time of Aretæus), that the disease is less dangerous in the
middle part of life than as either extreme is approached, is probably
an erroneous one. Yandell, from the analysis of the cases he had
collected, found that the mortality was greatest in children under ten,
and least in individuals between ten and twenty years old. Kane's
statistics would place the time of greatest danger in the early adult
period, from the age of twenty to that of thirty-five or forty.

In traumatic cases the location of the wound does not seem to

materially influence the death-rate. As occurring during our late war,
those associated with injuries of the upper extremity were the least,
and of the head, face, and neck the most, fatal, but the difference in
the mortality rates was but 8.4 per cent. (86.8:95.2 per cent.). It has
long been believed that wounds of parts supplied by the cranial
nerves are not only less often followed by tetanus than those of other
regions, but that the disease when present is of a less fatal
character. Of the 10 cases of the peculiar head-tetanus already
referred to, collected by Bernhardt, 6 died (60 per cent.).

TREATMENT.—For the relief of tetanus agents of most diverse action

and power have been employed, intended to control inflammation,
allay nervous irritability, arrest spasm, and sustain the general
strength; and operations have been performed with the view to
destroy nerve-conduction, remove external irritants, change the
character of the associated wound, or take away the originally
damaged part. Much of the confusion and uncertainty that have
prevailed respecting the therapeutic treatment has doubtless arisen
from the want of distinct separation of the idiopathic from the
traumatic cases, because of incorrect diagnosis, or through an
unwarranted assumption of the general applicability of a method of
medication found advantageous in individual cases of perhaps
rheumatic, malarial, or meningeal disease.

Regarding the affection as inflammatory, the older surgeons treated

it antiphlogistically, and until within comparatively recent times
bloodletting and mercury were largely employed. General and local
bleedings, resorted to as far back as the time of Hippocrates, were
not seldom made in excessive amounts,13 the patient occasionally
surviving both the disease and the treatment. The mercurials were
pushed until profuse ptyalism was produced—a condition which
could but add to the distress (because of the great difficulty
experienced in clearing the throat and mouth), and likely to induce
and increase the severity of the convulsive seizures. Combined with
opium, calomel was formerly held in high repute, and numerous
recoveries have been attributed to such treatment—recoveries,
however, almost always of cases of chronic character and no great
severity. Should the mycotic origin of the disease ever be
demonstrated, there will be good reason, in its well-known
destructive action upon minute organisms, for the administration of
the mild or corrosive chloride of mercury. Cold baths and affusions
have sometimes caused entire relaxation of the spasms, leaving the
patient as supple as a glove, and not seldom have been followed by
muscular ruptures or sudden death.14 The local application of ice to
the spine has been credited with many cures, particularly of cases of
the non-traumatic variety, and benefit has seemed to follow the
employment of ether or rhigoline spray. Hot baths, water or air,
general or local, have been largely used from the time of Paré down,
and the induced free perspiration has in some instances seemed to
have been of service, as have the medicinal agents acting as
sudorifics, of which jaborandi has of late been the one ordinarily
employed. “To relieve the contractions and provoke sweating are the
two principal bases of treatment,” wrote Martin de Pedro. But it
should not be forgotten that in many of the more severe and rapidly-
fatal attacks profuse sweating is characteristic of the disease.
13 In a case of Lisfranc's, in twenty-six days venesection was made nineteen times,
and seven hundred and seventy-two leeches were applied.

14 An interesting and frequently-mentioned case is reported by Sir James McGrigor. A

soldier having tetanus (unusually severe) was “during the first part of the day
drenched with rain, the thermometer standing at 52°, but after ascending one of the
highest mountains in Galicia the snow was knee-deep and the thermometer below
30°. The patient was exposed to this inclement weather from six o'clock in the
morning till ten at night, when he arrived half starved to death, but perfectly free from
every symptom of tetanus.”

All violent depleting measures should be abstained from, since in the

acute attacks they can do no good, and in the more chronic ones
can only increase the general debility; and it is from exhaustion that
the subjects of these latter usually die.

To lessen the reflex irritability, to quiet the muscular spasms, and

support the patient are the prime indications; to fulfil which every
agent in the materia medica that has, or has been supposed to have,
any sedative action upon the nervous system has been employed,
as well as remedies directly controlling muscular movements. Of the
greater number of such it may be truly said, “They have the same
value, and the best of them is good for nothing” (Giraldes).

At the present time the medicinal agents that are deserving of

consideration are tobacco, the anæsthetics, curare, conium,
cannabis indica, calabar, opium, chloral, and the bromides.

Tobacco, that in virtue of its depressant action so powerfully relaxes

the muscles, was until the introduction of the anæsthetics largely
employed and regarded with much favor, but of late years has rarely
been used, inhalations of chloroform or ether securing more rapid
and complete relaxation, with far less danger to the patient. Nicotine,
in doses of from a fraction of a minim to a full minim (6/10 gr.) by the
mouth, or two by the rectum (Houghton), has been given instead of
the tobacco infusions with equally good effects, and of course the
same dangers of producing fatal collapse.

The anæsthetics, chloroform and ether, have been frequently

administered, but although muscular relaxation and sleep have been
thereby secured, the natural progress of the disease toward a fatal
termination has not been materially affected: death has at times
been directly and suddenly produced, and not infrequently, though
the inhalations have lessened suffering, they have seemed to hasten
the end.

Curare, which “powerfully impairs and destroys the conductivity of

motor nerves,” and of which, consequently, much was hoped at one
time, has proved to be of but little value.15 In order that benefit may
follow its administration the agent must be given in large doses and
until a decided impression is made upon the innervation of the
muscles of respiration, great danger meanwhile existing of producing
asphyxia, for the relief of which artificial respiration must be
instituted. McArdle of Dublin, in reporting recently a successful case
of the acute variety in which gr. ⅔ was given every fifth hour,
suggested the combination of curare and pilocarpine, “in the hope
that the cardiac and respiratory trouble produced by the former might
be prevented by the latter.” Uncertain in composition, cumulative in
action, “dangerous, difficult to manage, and variable in its effects,”
curare is not, so far as has as yet been determined, an agent to be
recommended in the treatment of tetanus.
15 Of Demme's 22 cases, 14 died (63.6 per cent.); of Busch's 11 cases, 6 died (54.5
per cent.); and in 51 cases collected by Knecht the mortality-rate was 49 per cent.

Conium, the action of which is much akin to that of curare, and which
primarily is upon the terminal portions of the motor nerves, has been
occasionally employed—successfully in two cases by Christopher
Johnson of Baltimore, who gave it hypodermically in doses of from 1/6
to 2 minims every one, two, or three hours. In two other cases under
the care of the same surgeon death took place, but the remedy
seemed to have acted beneficially in relieving the spasms and
relaxing the tonic rigidity.

Calabar bean—which produces a paralyzing action on the spinal

cord, abolishing its reflex functions, and later “diminishes and
destroys the conductivity of the motor nerves”—though apparently of
service in certain cases (almost all of them, however, in young
subjects and of chronic character), has proved to be of little or no
more value than other less dangerous agents. It was first clinically
employed by Vella in the Italian war of 1859. Of the 39 cases in
Yandell's table, 39 per cent. recovered; of the 60 in Knecht's, 45 per
cent.; and of the 60 collected by H. C. Wood, 55 per cent. It may be
administered by the mouth, the rectum, or subcutaneously in doses
(of the extract) of from ⅓ gr. to 2 grs. every quarter hour, half hour,
hour, or two hours (Ringer gave 4 grs. in an hour),16 according to the
violence of the symptoms, being stopped when there is produced
“vomiting, diarrhœa, or a rapid small pulse and clammy sweat.” Yet
its beneficial action in severe cases is only manifested when it has
been “pushed to the extent of rendering the patient collapsed, the
temperature of his body falling perhaps to 94° or 95° F., the pulse
being hardly perceptible at the wrist” (Macnamara); under which
circumstances there is about as great risk of death from the
treatment as from the disease itself. Always, fever is a
contraindication to its employment.
16 E. Watson gave to a patient in the course of forty-three days the equivalent of 1026
grs. of the solid extract, a tincture of the powdered bean being largely employed.

Cannabis indica, originally used by the East Indian surgeons, and

believed by them to have a powerful influence in controlling the
tetanic spasms, has proved much less efficacious in cases occurring
in Europe and this country, perhaps because of the unreliable
character of the extract used; though of 42 cases of the traumatic
variety treated in the Chadnie Hospital at Calcutta in five years
(1865-69), 62 per cent., and of 39 idiopathic cases 40 per cent.,
died, and of Chuckerbutty's 13 cases in India, 6 (i.e. 46 per cent.)
died. Of the 25 cases in Yandell's table, the mortality-rate was 36 per
cent. If given, it should be in doses of from ½ to 2, or even 4, grs. of
the extract, or minim 15 to drachm j of the tincture, every two or
three hours. Having a strong hypnotic action, it is to this probably
that the beneficial effects of its administration are due, rather than to
its secondary influence upon sensation and muscular movements.

Of all the sedatives and narcotics, opium has been longest and most
often used, and in so far as it relieves pain and causes sleep it is of
service. Like the other agents, it must be administered in large
doses, reference being had to the effect produced and not to the
number of grains given. The difficulty of swallowing even the liquid
preparations has of late years made the hypodermic injections of
morphia the favorite mode of administering the drug. Demarquay has
advised that the solution (1 part to 50 of water) should be thrown
deeply into the substance of the affected muscles, as near as
possible to the place of entrance of their supplying nerves; the result
being to especially relieve the trismus and allow of the taking of food.
Fayrer in India found opium-smoking of advantage. The mortality-
rate of the 185 cases tabulated by Yandell treated with opium was 43
per cent., but, as is true of the other drugs that have been referred
to, it is chiefly if not wholly in the mild and chronic cases that the
beneficial effects have been observed.

So far as has yet been determined, chloral is our most valuable drug
in the treatment of tetanus, as it is in that of the allied condition of
strychnia-poisoning—not because of any direct antidotal action, but
by reason of its producing sleep, lessening the reflex irritability of the
spinal cord, and diminishing the violence and frequency of the
muscular spasms, thus enabling the patient to keep alive until the
morbid state can spontaneously disappear. Given usually by the
mouth or the rectum, it has been administered hypodermically (as
much as 5 grs. at a time by Salter) or, as proposed by Oré, thrown
directly into a vein. If it is true, as has been claimed, that its
beneficial effect is due entirely to the sleep secured (not infrequently
after waking up the spasms return with increased violence), the drug
should be administered in doses sufficiently large and repeated to
maintain a continuous slumber. Verneuil (whose therapeutic formula
has three terms, rest, warmth, sleep) has found that while with
certain patients a drachm a day is enough, to others four times as
much must be given, and directs that the chloralic coma be
continued for about twenty days. Further experience may show that
small doses may suffice to secure the needed quiet—as, e.g., the 40
grs. at bedtime, with, if necessary, 30 grs. more at midday,
recommended by Macnamara. Such small doses are far safer than
the enormous ones that have at times been employed,17 since
chloral can exert a powerful toxic influence upon the circulatory and
respiratory centres, death being almost always due to arrest of
respiration, though in tetanic cases it may be the effect of slight
spasm upon a heart the enfeebled state of which is indicated by a
very rapid and thready pulse. The intravenous injections expose the
patient further to the risk of the formation of clots and plugging of the
pulmonary artery, several instances of which accident have already
been reported, though this method of treatment has but seldom been
employed. The death-rate of those treated by chloral alone was 41
per cent. in the 134 cases analyzed by Knecht, and 41.3 per cent. of
the 228 tabulated by Kane.
17 Beck is reported to have given 420 grs. in three and a half hours, and Carruthers
1140 grs. in six days; both patients recovered—Beck's after a continuous sleep of
thirty hours. In one case the chloral sleep was maintained without interruption for
eight days, from 250 to 300 grains a day being given; and in another, which also
recovered, over 3000 grs. were taken in the course of thirty-eight days.

Of late years use has been made, either alone or in combination with
opium or chloral, of the bromides, especially that of potassium, which
in full dose unquestionably diminishes reflex irritability, lessens the
sensibility of the peripheral nerves, and moderates excessive body-
heat. Under its influence mild cases of tetanus have recovered and
more severe ones been somewhat relieved, and it has the decided
advantage over the other drugs that have been noticed of not being
a direct cause of death even when given in large dose—as much in
some instances as six, seven, or nearly eight drachms a day. Knecht
found that of 10 cases treated with chloral and the bromide, 9 got
well; and Kane, of 21 to whom such a combination was given, only 5
died (23.8 per cent.); but the number of cases is too small to make
conclusions deduced therefrom of any special value. Voisin reports a
case (in which it should be noted the spasms began in parts near the
wound, and that on the fourteenth day after the receipt of the
gunshot injury of the right thigh) that had for eleven days been
treated without effect with chloral in large quantity, which at the end
of that time was put upon drachm ij doses of the bromide, with three
hypodermics a day of about ½ gr. of morphia each: in three days
decided improvement had taken place, and in four days more the
patient was well.

The sedative and sustaining action of alcohol has many times been
taken advantage of in the treatment of this affection. The
administration of wines or spirits in large amounts has certainly been
found of much service, though it will seldom or never be necessary
to give wine, as Rush advised, “in quarts, and even gallons, daily.”
80 per cent. of recoveries appear to have taken place in the 33
cases that Yandell found to have been treated with stimulants; but,
on the other hand, of Poland's 15 cases treated with wine, 75 per
cent. died: here, again, the numbers are too few to make any
deduced conclusions of much value.

As tetanus (or at least tetanoid spasm) has at times been observed

as a consequence of malarial poisoning, and successfully treated
with quinine, this remedy has occasionally been employed in cases
not dependent upon paludism, but very generally to no purpose.

Fowler's solution of arsenic in doses of from 5 to 20 minims every

two, three, or four hours has been believed by certain of our
American surgeons (Hodgen, Prewitt, Byrd) to be of service.

Because of the supposed origin of the disease in peripheral nerve-

inflammation or irritation, operative procedures have many times
been adopted to interrupt the conduction or remove the part.

Amputation, which was so highly commended by Larrey, is now

recognized as of no service in the severer and more acute cases,
and as unnecessary mutilations in the chronic ones; and if performed
in those of intermediate severity, when recovery takes place it will
generally be difficult or impossible to determine of how much benefit
the operation really was, and in some at least of the fatal cases the
result can fairly be attributed to the amputation itself. When the
disease is associated with an extensive lesion of an extremity, there
can be no objection to the removal of the damaged part (if performed
early), except that it may by the added shock still further weaken the
patient and render him less able to hold out against the tetanus. In
cases of severe spasms limited to the muscles of the injured limb
(and such are frequently said to be of tetanus) amputation is often
strongly indicated, and not seldom is the only treatment that will
afford relief. During our late war “amputation was resorted to in 29
instances after incipient tetanic symptoms; 10 of the cases resulted
favorably, and in several instances it is noted that the symptoms
ceased after the operation.”18 Of Yandell's 17 cases, 60 per cent.
recovered.
18 Medical and Surgical History of the War of the Rebellion.

As there is here, apparently, recovery in 34.5 per cent. of the gunshot cases treated
by amputation (nearly one-fifth of all the non-fatal cases reported)—a very gratifying
degree of success, and one that might properly encourage the resorting to this
method of treatment—somewhat careful analysis may well be made of the 7 cases
the histories of which are given. In 2, shell wounds of the foot, operated upon by the
same surgeon, the disease appeared while the men were still upon the field. Of one
of them it is stated that “there was but little hemorrhage, but the shock was excessive
and tetanic symptoms were present;” and of the other, that “the peculiarities in the
case were that symptoms of tetanus were quite marked, with great exhaustion.” There
are certainly good reasons for believing that these two cases were not of tetanus, but
of simple convulsive movements from shock and anæmia. Of the remaining 5 cases,
the symptoms manifested themselves on the fourteenth, nineteenth, twenty-first,
thirty-fifth, and fifty-fourth day after the receipt of the wound. One of the patients (in
whom the disease was longest delayed), having a much inflamed and suppurating
compound fracture of the bones of the forearm, “was suddenly seized with a chill
followed by threatening tetanus,” and amputation was made the following day. In
another (thirty-fifth day case) the “arm became much swollen and symptoms of
tetanus ensued, including stiffening of the jaws, great pain and restlessness, and
irritable pulse;” two days later the limb was removed, and “all symptoms of tetanus
disappeared after the operation.” In another (twenty-first day) the man when admitted
into hospital, one month after the date of the injury, stated that “he was first taken with
trismus about a week before.” “As he was certainly getting worse every day,” the
forearm was removed forty days after the receipt of the wound and nearly three
weeks after the commencement of the tetanic symptoms. Other remedies employed
after the operation (brandy, chloroform, and blisters to the spine) doing no good,
drachm ss doses of the tr. cannabis indica were given every two hours, “under which
the patient slowly improved.” In another case (nineteen days) the symptoms were
those of tetanus; the amputation was made on the following day; twenty-four hours
later “rigidity of the muscles had partly disappeared, and improvement continued until
the patient was entirely relieved.” In the remaining case (fourteen days) the first
symptoms of tetanus “were relieved by active purgatives, calomel, etc. Three days
later the symptoms returned,” and on the next day “tetanus supervened in its usual
form.” Five days afterward “the leg was amputated at the middle third, after which the
tetanus subsided and the patient made a rapid and good recovery.”