Puerperal tetanus is rarely recovered from, and the tetanus neonatorum of in fants is almost always fatal The prognosis of tetanus of the new born is not so bad as formerly thought. Eight eases recovered out of forty col lected. J. L. Smith (Arch. of Ped., Dec., '95).
In 6 cases of puerperal tetanus person ally observed, there was operative inter ference with the labor in all. Chill, fever, and fcetid lochia were all present. The symptoms came on in from 6 to 19 days after the delivery, being uniformly fatal in from 2 to 3 days. All of the reported eases, 21 in number, have been collected, showing that in 1 case only did recovery take place. Rubeska (Archiv f. Gyniik., vol. liv, No. 1, TS).
(See also ECLAMPSIA, PUERPERAL, V01 ii.) The least dangerous cases arc those in which the spasm remains localized in the jaw- and neck- muscles.
The afebrile cases offer a more hopeful outlook than do those in which the tem perature is elevated. The number and violence of the paroxysms bear a direct relationship to the severity of the dis ease. When these paroxysms are fre quent, severe, and involve all muscles of the trunk, recovery is scarcely hoped for.
Treatment.—The most important ther apeutic question at the present time is as to the value of the tetanus antitoxin. It has been observed that animals which are very slightly susceptible to tetanus, such as the dog, may be rendered im mune by the injection into their tissues of the tetanus-virus, in doses of gradu ally increasing strength; and that the serum of animals so treated has the power of conferring immunity upon other more susceptible animals, or of at least in creasing their power of resistance to the tetanic toxins. The serum of immunized animals may be preserved for use by the addition of a small proportion of car bolic acid. The tetanic antitoxin of Tizzoni and Cantani is obtained from the serum of immunized dogs by treatment with alcohol. Experiments upon the lower animals with the tetanus antitoxin show that animals inoculated with fatal doses of tetanic virus often recover when treated with antitoxin.
The results thus far obtained by the antitoxin treatment in man, however, have not been especially favorable, prob ably on account of the fact that the existence of tetanus is unsuspected until the amount of the poison is sufficient to cause spasm and too late to give good re sults from any specific treatment. Some
favorable effect is, however, often noted, and the antitoxin or immunized serum should always be used, as it is probably the best single remedy now at hand. It is manufactured on a large scale in some what the same manner as is diphtherial antitoxin, and can be procured of almost all prescription druggists.
In giving intracerebral injections the following method is recommended: The anterior half of the scalp is first shaved and cleansed, then the point at which the injection is to be given is determined with the aid of a craniometer. In order to inject the fluid into the lateral ven tricles, so as to avoid the motor centres, a point, 2 'A to 3 centimetres from the bregma has been found to meet all indi cations. After cocainizing the scalp in this region a hole is drilled through the scalp and cranium; upon withdrawal of the bone-urill, the hypodermic syringe is inserted and the medicated fluid in jected into the lateral ventricles. Al bert Kocher (Centralb. f. Chir., No. 22, '99).
From an examination of recent litera ture a list has been compiled of 25 pa tients treated by the intracerebral in jection of antitoxin, with 11 recoveries and 14 deaths. Intracerebral injection does not interfere with treatment by hypodermic or intravenous injection of antitoxin, and the causative wound must be dealt with by thorough scraping and disinfection, or by amputation. Albert Carless (Practitioner, July, '99).
The following case should inspire greater confidence and hope in the cura tive effects of the injection of antitoxin into the dura mater. The wife of a cab inet-maker, aged 29, on June 2d, fell down the cellar-stairs, and, being in the third month of pregnancy, aborted the next day. On June 13th signs of tetanus ap peared. The symptoms were unusually severe, and the prognosis most unfavor able. Altogether the woman received 9 grammes of antitoxin,-4 of Behring's serum and 5 of Tizzoni's,—nearly twice the supposed curative dose, and half of it in the dural sac. On the seventeenth day of the disease she was in good spirits, and in a satisfactory condition, though the trismus had not entirely dis appeared, with a pulse of 108 to 120. V. Leyden (Berl. klin. Woch., No. 29, '99).