Of drugs there is practically no end, every known sedative having been at some time or other tried, and supposed to have turned the tide against the microbe. They may be used to keep the patient alive till the poison exhausts itself by elimination, and in the very worst cases relief of suffering may he obtained.
Carbolic Acid injected hypodermically in r per cent. solution was first tried by Baccelli. As much as 55 grs. pure acid have been injected during the entire 24 hours without any symptoms of poisoning having appeared, even when the treatment has been prolonged over a week or more. Thus 30 mins. 3 per cent. solution may be given every hour for 16 hours of the waking day. The toxremia which causes the disease appears to prevent any toxic effects of the acid. The use of carbolic acid was discountenanced by the war authorities. Bromides and Chloral may be employed by the mouth at the same time.
Magnesium Sulphate solution (I in 4) has been frequently employed as an injection into the spinal canal; 3 c.c. produce spinal anmsthesia and prevent the spasms for many hours at a time. This remedy is (not withstanding some favourable results) passing into disuse.
Eucaine alone or with Morphia has similarly been employed, and sometimes with benefit. Cocaine is more toxic and should not be used.
Bromide of Potassium in full doses generally somewhat diminishes the spasms, and a few mild chronic cases have been reported as cured under its influence, hut it need not be relied upon where the symptoms are severe, unless it be given in combination with the next drug.
Chloretone and Chloral Hydrate have been used in many cases which have recovered, and there are some grounds for believing that they may save life occasionally. Whichever drug is selected must be pushed till the full physiological effects are observed, 3o-gr. doses being given every 3 hours, or 15 grs. every hour or every second hour till some impression is made upon the symptoms.
Opium by mouth or Morphia hypodermically may he pushed with less danger than chloral, whose depressing influence upon the heart may make itself felt before drowsiness appears. These drugs should be given in proportion to the spasms and pain, no attention being paid to the amount of the dose. In prescribing narcotics in this disease, it must be borne in mind that enormous doses may be given. Some physicians combine chloral and opium. Cannabis Indica may be pushed like opium; it is often given with chloral, but it is less reliable than morphia.
Alcohol in very large doses, Tobacco in nauseating doses, Nicoiine and Tartar Emetic have been pushed till sickness comes on. Apomorphine, Lobelia and other depressants have been tried, and in a limited number of cases appear to have done some good. Of the series, Alcohol is the
safest; most of them are useless as well as dangerous.
Chloroform or Ether affords the only relief in very acute cases coming on soon after the wound has been inflicted. In this group of cases anesthesia may be kept up for many hours at a time, and it may be pushed even when death is evidently approaching, as the only way of relieving suffering.
Curara, after a fair trial, has likewise lost ground, and though now and then cases are reported which seem to show that it has done good, just as often are those set aside by complete failures.
Extract of Physostigma has been pushed to the extent of # gr. every hour till paralysis of the voluntary muscles has been produced, and good results have been reported in several cases.
Cholesterin has been stated to possess such an affinity for the tetanus toxin that if injected it will fix the poison before this attacks the nerve substance; 2-dr. doses of a r per cent. solution have been injected hypodermically every 2 or 3 hours, but the results have been disap pointing.
Pilocarpine, I gr. hypodermically, may be tried when other agents have failed. It probably acts as a diaphoretic by hastening the elimination of the poison.
Atropine injected into the muscles, or Belladonna and Flyosevamus, Gelsemium and Conium by the mouth, in doses sufficient to produce toxic symptoms, have been recommended.
Nitrite of Amyl possesses the power of minimising or checking spasm of the glottis, and Nitroglycerin occasionally appears to give some relief according to several reports; and the former drug should be resorted to the moment that a spasm threatens.
Trismus Neonatorwn may he regarded as the same affection as tetanus in the adult, and must be met by the same remedies. Westcott has drawn attention to the danger of tetanus being conveyed by the use of Fuller's Earth and other mineral dusting powders which arc applied to the stump of the umbilical vein and to sores on the nates of infants. In addition to serum-therapy, which has been successful in a few cases, Chloral is the only drug to be depended upon, and the writer has satisfied himself about the great value of it when steadily pushed in the case of infants. i gr. may be given by the mouth or by the bowel every hour. The utmost cleanliness in the dressing of the stump of the umbilical cord must he attended to, as this affection is liable to spread amongst new-born infants. Soltman recommends gr. of Musk every 3 hours when hourly doses of Moral for 24 times have failed.