Death usually occurs at the end of a day or two. The infant seldom recovers if the paroxysms have appeared before the third day after birth. If the child live six days after the appearance of the first symptoms, the case may terminate favourably.
In Mr. Parker's case, before referred to, the arms were noticed to be, stiff immediately after birth, and they could not be flexed. For a day or two the child sucked without difficulty, then the milk was observed to run out of his mouth. On the fifth day, soon after the navel-string fell off, he began to have slight spasms. If the nipple was put into his mouth the spasms were immediately excited. On admission on the fifth day the cranial bones presented uo abnormality. The child lay with the eyelids screwed up. His mouth was not quite closed, but any attempt to open it wider brought on a spasm. There was no risus sardonicus. When. stripped, the child's body was seen to be covered with haemorrhagic flea bites. The umbilicus was slightly red and inflamed, but there was no dis charge from it. There were no marks of violence, nor any sores of any kind about the body. The limbs were rigid and outstretched, the legs rather less so than the arms ; the hands were clenched. The abdominal and thoracic walls were also rigid during the spasm, but they partially re laxed after the spasm had passed off. The limbs never quite relaxed dur ing the intervals. The spasms were of short duration (a quarter to half a minute), and affected the whole body at once. They recurred very rapidly, and the slightest touch sufficed to bring them on. Respiration was quite arrested during the paroxysm. There was no opisthotonos. The temper ature, taken in the rectum, was 103.8°.
The case was treated with the calabar bean extract, of which one-sixth of a grain was given every half hour by the mouth ; but as the infant was unable to swallow, probably very little of the remedy was really introduced into the system. Still, possibly some was absorbed, for after several doses the child opened his eyes and was able to swallow milk. He was then placed in a warm bath and the bean extract was given every two hours.
The infant had some spasms during the bath, and a few others shortly afterwards, but in the course of an hour they ceased entirely and the child seemed to be going on well, when suddenly a violent paroxysm came on and he died asphyxiated. The temperature varied, after the first, be tween 100.8° and 102.4°. The child lived only about sixteen hours after his admission into the hospital.
In fatal cases the duration of the illness is usually short. Sometimes the infant dies in a few hours, and in the majority of cases all is over be fore the end of the second day. More rarely the child makes a better struggle for life, and only succumbs on the eighth or ninth day. When the disease takes a mild form from the beginning it may terminate favour ably after a more or less serious illness of two or three weeks.
When tetanus attacks children after the age of infancy, the symptoms are similar to those which are seen in the adult. They are well illustrated by the following case of idiopathic tetanus which was under my care in the East London Children's Hospital.
A boy, aged ten years, complained one day on returning from school of chilliness, and shivered. For the next three days he seemed poorly and complained constantly of feeling cold. On the fourth day, in the evening, his neck became stiff, and the stiffness extended to between the shoulders so that he held his head backwards. On the following day (the fifth) he began to " get straight" from the hips upwards, and the stiffness soon ex tended to the feet. Although very ill, he would sit up in a chair during the day, and on one occasion, on being raised to his feet at his own re quest, he became perfectly stiff so that his mother could not bend him or replace him in his chair. After about a minute the rigidity subsided and he resumed his seat. He complained of no pain except from his tongue, which he often bit in these attacks. After this the stiffness returned when ever he moved. His mind was quite clear, but except for asking for what he wanted he did not talk. The bowels were much confined.