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Tetanus or

disease, died, inflammation, days, infantile, traumatic and children

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TETANUS or lock-jaw, as it attacks new-born children, is a disease of which in England we know little by actual experience. A few cases are, however, seen from time to time, and it is not unlikely that but for the tender age of the infant attacked, and the rapidity with which the disease hurries to a close, more examples of the malady might come under observation. Cer tainly, at the east end of London, in the Irish quarters, where squalor and poverty are often extreme, it is strangely common to hear of several infants of a family having died a few days after birth from " convulsions." Such cases have probably come under the notice of no more experienced obser ver than an ordinary midwife, and it is quite possible that many cases of infantile tetanus may thus escape recognition.

The disease consists in an intense irritability of the spinal cord and the motor nerves which proceed from it, throwing the whole body into violent tonic spasms. Infantile tetanus runs a very acute course and generally ends in death. It is common in the West Indian islands, in South America, and in the southern portion of the United States. In these warm climates it attacks by preference the new-born children of the negro population. It is also occasionally found in more temperate zones. The island of St. Kilda in the Hebrides has long been notorious for its enormclus infant mor tality from this cause, and sometimes in other parts of Europe the disease occurs sporadically or even in occasional epidemics.

speculation has been bestowed upon the etiology of the disease as it occurs in new-born infants, and many theories have been devised to account for it. The fact that the symptoms appear within a few days of birth seems to point to some traumatic cause for the illness, and suspicion naturally fell at once upon the remnant of the newly divided um bilical cord. Hence the disease has been ascribed to phlebitis of the um bilical veins. The explanation has, however, been proved to be erroneous. Dr. Mildner, of Prague, has collected forty-six cases of inflammation of the umbilical vessels which ended fatally. hi only five of these did convulsions form part of the symptoms, and in no instance did the convulsions bear any resemblance to those characteristic of tetanus. Again, phlebitis of the umbilical veins, although an occasional accompaniment of infantile tetanus,.

is more often absent than present. Inflammation, then, cannot be a cause of the disease, but still it does not follow that tetanus is independent of the condition of the cord. Even in the adult inflammation of a wound is not essential to the production of traumatic lockjaw, for the malady has been known to occur in cases where the wound had undergone healthy cicatrisation.

Mechanical causes for the disease, such as blows or accidental injuries. and the use of too hot water for the bath, have been suggested by some authors. An eminent American writer has attributed the disorder to press ure on the medulla oblongata and its nerves, through displacement oc curring either during labour, or after birth from the child being allowed to lie for days together with the back of his head upon a pillow.

Although the disease may arise from these or other traumatic causes, it seems likely that an explanation of the phenomena is to be found in general rather than in local agencies. The influence of sudden changes of temperature in producing tetanus hardly admits of doubt. In all countries where the complaint is prevalent there are rapid alternations of tempera ture, the heat of the day passing suddenly into the cool of the evening. On this account interruption to the functions of the skin has been suggested as the immediate cause of the disease. In the same way chilling of the surface by exposure to cold and wet has been said to be capable of exciting the tetanic convulsion. Of all causes, however, to which the disease has been attributed foul air generated by filth and imperfect ventilation is, perhaps, one of the best established. The often quoted case of the Dublin Lying-in-Asylum seems to prove this conclusively. Before 1772 nearly one in every six. of the children born alive in the asylum died, and the cause of death was almost invariably tetanus. In that year Dr. Joseph Clarke intro duced a complete system of ventilation into the hospital. The consequence was that the mortality immediately fell to one in nineteen. Later, the proportion of deaths was still further reduced to one in fifty-eight, and of those who died little more than a ninth died from this disease.

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