The practice of surgery : a treatise on surgery for the use of practitioners and students / by Henry R. Wharton ... and B. Farquhar Curtis.

  • Wharton, Henry R. (Henry Redwood), 1853-1925
Date:
1902
Catalogue details

Licence: Public Domain Mark

Credit: The practice of surgery : a treatise on surgery for the use of practitioners and students / by Henry R. Wharton ... and B. Farquhar Curtis. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

    88/1268 (page 72)
    apt to terminate fatallj', while the so-called chronic cases, in which the dis- ease usually develops slowly and some time after infection, run a course of from four to twelve weeks, and not infrecxueutly recover. Death has been known to occur within a few hours of the infection, and frequently takes place within one day after the first symptom. If the patient survive for ten days or a fortnight, recovery may be expected. The mortality has been estimated at ninety per cent, for the acute, and forty per cent, for th^ chronic cases, without antitoxine treatment (Lambert). Facial, Paralytic, or Hydrophobic Tetanus.—One peculiar variety of tetanus deserves separate consideration,—namely, that which fol- lows wounds in the distribution of the cranial nerves, the so-called facial or head tetanus, also known as hj-drophobic or paralytic tetanus. It is marked by the occm-rence of paralysis in the muscles most affected (usually those supplied by the facial nerve) and by reflex spasm of the oesophagus, which is in some cases so marked as closely to resemble hydrophobia. The disease begins with contracture of the muscles nearest the injury, on both sides of the face if the wound is in the middle line, otherwise unilateral, followed by spasms, gradually extending to the muscles of the other side, while those first affected become paralyzed. If the infection is severe the symptoms of general tetanus follow, with a mortality of seventy per cent. (Willard), and the mortality of all cases is only fifty-eight per cent. (Brunner), showing that, as a rule, the disease is milder than ordinary tetanus. The paralj'sis is easily overlooked if not sought for, and in some cases there is none. The instances of marked oesophageal s^jasm are rather rare. The paralysis depends uj)on a paralyzing agent among the toxiues of the tetanus bacillus. It is always limited to the part first affected, although the spasms generally extend to the rest of the body. Treatment.—The most important recent addition to treatment has been the discovery of the apparent curative effects of the tetanus antitoxine by Tizzoni and Cattani. The protective serum is obtained by injecting animals with sterilized cultures of the germ until they become immune, and draw- ing blood-serum from them. It is also possible to obtain an antitoxine from laboratory cultures of the bacillus (Behring). The antitoxine may be in- jected hyijodermically, into the spinal canal, into the brain through a small trephine opening, or diluted with normal salt solution and thrown into a vein. Which is the best of these methods is still uncertain, but in any case the ordinary treatment by local disinfection of any suppurating lesion and the use of drugs must not be neglected. The antitoxine should be given within thirty hours after symptoms have begun if any eifect is to be ob- tained. In cases treated by antitoxine, Lambert found a mortality of only forty per cent.,—seventy-five per cent, in forty-seven acute cases, and six- teen ]Der cent, in sixty-one chronic cases. Wasserman discovered that normal brain-substance contained a natural antitoxine to tetanus, and ten cases with eight cures are on record as having been treated with subcutaneous injection of fresh rabbit-brain made into an emulsion. We must also mention Baccelli's method of ti'eatment by hypodermic injections of a two per cent, solution of carbolic acid in large doses, which has given remark- able results according to Italian reports.