Cephalic tetanus, general tetanus associated with hemifacial paralysis, recovery / by De Forest Willard ; assisted by James I. Johnston.

  • Willard, De Forest, 1846-1910.
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: Cephalic tetanus, general tetanus associated with hemifacial paralysis, recovery / by De Forest Willard ; assisted by James I. Johnston. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    seventy-five grains of bromide, thirty grains of chloral, and thirty-six drops of tincture opium deodorata. These doses were maintained steadily for four or five weeks. He was never narcotized, and during the day slept but little. On December 15, when he became so noisy and unmanageable, he was given one-eighth of a grain of morphia hypodermically, which was the only hypodermic given. At no time were we called upon to give an anesthetic for convulsions. When he began to convalesce and was on a fuller diet milk-punches containing two drachms of whiskey were given three times a day. • On February 15 the patient was discharged from the wards cured. All signs of facial paralysis were absent and the boy was the picture of health. During the early part of attack an attempt to procure and use the antitoxin for tetanus, as recommended by Tizzoni and Cattani,' was made, which proved futile, as none could be obtained. This was unfortunate for the antitetanin, but possibly not for the boy, as he is now entirely recovered, and the plan of treatment by antitoxins is still in its experimental stage. When dealing with a poison of such intense virulence, however, as that of tetanus any and all means of cure should be employed. At the time I was deeply disappointed at the failure to secure the antitoxin, but the favorable result under the plan of treatment adopted is most satisfactory. Klemm,' as well as Brunner, believes that the injury need not be limited to the distribution of the facial nerves, but that the paralysis, which is toxic, may be due to injury of any of the cranial nerves. Klemm very properly draws a distinction between the cases where the spasm remains limited to the muscles affected by the initial symptoms, as in true cephalic tetanus and in those (as in the case under consider- ation) where the spasm becomes general and in whom the conditions practically become those of ordinary tetanus. It is advisable to dis- tinguish such cases from those not associated with paralysis. It is quite possible that all cases of tetanus commence with these local spasms in the region of the injury ; but the local condition, being in the hand or foot, is unobserved, especially in acute cases where moie prominent symptoms speedily develop. The facial region being so abundantly supplied with nerve filaments is probably more susceptible to irritation of the tetanus bacillus and is a most favorable infection- atrium. The facial muscle-mechanism is also exceedingly delicate. The presence of this bacillus in the earth must be limited, as a very large proportion of injuries become soiled with earth. The poison of tetanus has two modes of action ; firsl, peripheral, ' Medical Press and Circular, London, 1894, lviii, 153 ; also Berliner kliuische Woclienschrift, 1S03, Vol. XXX, pp. 1185, I215, 1245, 1265; 1894, Vol. XXX, pp. 64, 772. 2 Berliner kliuische Wocliensclirift, 1S93. p. 63.