TETANUS NEONATORUM.

718 was

informed by

a

very

experienced

che-

profession feel

confident that the aconitum

mist, that the slighest particle accidentally napellus, or paniculatum, furnishes a recame into contact with the eye of a young medy of the merit which has been ascribed

gentleman in the laboratory; the most excrutiating pain was the result, followed by

to it.

I have known one instance only of its numbness of the side of the face; so rapid producing temporary relief, from my own a poison is it, that the fiftieth part of a grain, personal observation. Dr. TURNBUEL brings dissolved in diluted alkohol, killed a spar- forward seven cases of cure in neuralgic The gentleman whose case I have row in a few moments, and a very small disease. quantity, scarcely appreciable, destroyed a known has suffered for several years from small bird with the rapidity of lightning; pain in the face; it is not, after the most applied to the eye, however, it only produc- careful observation, periodic in its return ; it has no connection with disordered fuuced a momentary dilatation of the pupil. nitina, in its purest state, does not appear tion of digestion or nutrition, but is singu. capable of crystallizing ; it is white, in larly dependant upon mental emotion; from grains, or under the form of a colottrless anxiety it is supposed, indeed, to have mass, with a vitreous lustre. It is inodour- taken its exciting cause. Every remedy that ous, and bitter and acrid to the taste; this experience could suggest has been tried, acridity disappears quickly; it is very spar- and with temporary relief, occasionally, but ingly soluble in water, but easily soluble in the agony returns as acute as before; a alkohol and ether ; these solutions are alka- grain of aconitine to a drachm of lard was at line ; it is soluble in nitric acid, and in sul- first successfully rubbed, for nearly a quarphuric acid, a red-coloured solution being ter of an hour, upon the painful part, but a produced. relapse soon occurred ; the quantity of the The Royal College of Physicians has, in its alkali was increased, and again afforded new Pharmacopoeia, given some notes relat- temporary relief; it has, however, now ing chiefly to the chemical preparations ; completely ceased to have any effect; some these are most important additions to the degree of tingling and heat, and an unwonted rules laid down for the chemist and druggist, sensation, followed upon its use, which graand when the plan is more matured will be dually disappeared. The formula proposed of very great utility. Aconitina is thus by Dr.TURNBULL is two grains to the drachmn designated " an alkali, prepared from the of lard, and six drops of alkohol ; but other leaves and roots of aconite. It is very so- formularies have been given of the different luble in sulphuric asther, less in alkohol, remedies employed by him, to which I must and very slightly in water; it is totally con- refer you, as well as for the means he resumed in the fire, no salt of lime remaining." commends to obtain from the fresh root of The concluding remark is very necessary, the aconitum napellus, the aconitine,a grain and what is known of the alkali fully justi- of which, dissolved in a drachm of alkohol, fies the caution which is thus given :.°« It is so energetic, that twenty drops, put into is endowed with violent powers, and is not the mouth of a guinea-pig, occasioned death in a few minutes. rashly to be employed." It has been lately used as a therapeutic agent, and great stress has been laid upon its excellence in neuralgic disease. The profession, however, has not yet taken up TETANUS NEONATORUM. the subject with any of warmth, and, until MEMOIR BY DR. FINCKH, STUTTGARD. further proofs be obtained of its power, it can only be classed amongst those remedies which are to be tried when others, upon THE disease called " tetanus neonatorum," which we have been accustomed to place one of the most and dangerous reliance, have altogether failed. Indeed, the to which infantsunmanagable are subject, is described in di1iiculty of obtaining the pure aconitine, and the uncertainty of its preparation, are a very brief and imperfect manner in almost sufficient reasons for our not having made all treatises on diseases of children, whether further experiments. Some short time since, English or continental. Since the remarks I was informed by my friend, Mr. MORSON, of Dr. Clarke, and those of Schneider, which of Southampton-street, whose zeal in chewere published many years ago, nothing has mistry has led him to operate upon the been done to elucidate the nature or treatmonkshood and its alkali, and upon the alkalies of other vegetables, that its value was ment of this affection. The following obeighty pounds an ounce, or three shillings servations, therefore, merit attention, as and sixpence a grain. This price, however, being calculated to establish something wilnot be long maintained, as the herbalist in place of the vague notions which will of course grow a sufficient quantity to positive on this subject : they are answer any demand that may be made in generally prevail the market, its cultivation must become an taken from a memoir by Dr. ROBERT FINCKII, object of interest as soon as the medical published in " Hecker’s Annalen," Vol.III., a

Aco- i

719

No. 3, page 309, and founded

on

the obser-

cases of tetanus neonatorum, the Stuttgard hospital, between L occurring at the years 1828 and 1835, during which period 848 infants were received into that establishment. From this it would appear, that in some parts of Germany the disease is rather frequent. M. BILLARD only saw

vation of 25

two

cases

till des

during his residence

at the

IllJpi-

general collapse, and soon dies in complete exhaustion. This latter period is very often marked by febrile symptoms, with burning heat of the back and head, while the extremities are icy-cold. The state of the umbilical chord is one of the circumstances which demands especial attention. In a great majority of cases a coincidence has existed between the separation of the chord and the development of the tetanus : thus the chord was separated fourteen times before the appearance of spasms, nine times during, and only twice after, their commencement. Duration.—The duration of tetanus neo-natorum is generally short. In fifteen cases the disease terminated within two days ;,- -

in Paris. Dr. wliose memoir on cases in the Peters. burblz Hospital we published in a late iiiiiiiber of this Journal, saw 20 cases in 4,500 children, and Dr. COLI.INS saw but 37 cases one at Dublin, in ]G,Q54 children born during five

Enfllns T/’oltves,

*

protracted to a week, two to days; indeed it is almost incredible his mastership there. Of the twenty-five how long the tender constitution of the incase was

resist this dreadful ififiuits, alluded to by Dr. FiBCKtt, thirteen fant will sometimes Dr. Eleisser saw one single were hoys, and twelve girls, who were all malady ; thus, case which did not terminate before the born at the full period, and without having thirtv-flrst dav. suffered any violence during delivery : in Causes.—Dr. Finckh examines them at one case only had the mother been delivered some length, but we shall only give an auawith the forceps. It is also worthy of re- lysis of his remarks. It is impossible to refer the disease to congenital malformmark, that most of the cases occurred during ation, or weakness any of the infant, for all the then l’,n]iJ caacnn_ children were born at the full period, well Commencement qf the Disease,-Tetanus made, and many of them vigorous. The neonatorum generally commences during the doctor is inclined to rank, as more imiiiefirst week after birth. Thus, of the 25 cases diate causes, the convudsibility of new-born only one began on the second day ofthe children, and the suppuration or ulceration child’s existence, while eight cases occur- of the umbilical chord. Amongstoccasional red on the fifth day, and seven on the seventh. causes, the author enumerates atmospheric The prodromes of this disease are so uncer- influence, cold, gastric irritations, mechatain that we shall notice them but in a very nical stimuli, and injuries. With respect

-’

The child becomes uneasy ; manner. brief is seized with periodical fits of crying,

to the nature of the disease, he considers it to be essentially the same as the traumatic it takes of adults, and to be produced by a

which present a peculiar character ; tetanus the breast with avidity, but soon lets it go ; congestive or inflammatory condition of the the action of sucking is performed with diffi- central nervous system. Tetanus neonatoculty, or is impossible; the intestinal canal rum is generally considered to be more prevalent in warm climates than in any other ; /’0 is usually more or less deranged. : Symptoms.—As the disease becomes fully but the observations of Dr. Finckh tend, dt-veloped, the impossibility of sucking is certainly, to show that any exposure to cold, quite marked ;this is a very constant sign, especially during the cicatrization of the and did not fail once in the 25 cases.;The umbilical chord,is apt to determine tetanic infaut’s face assumes a contracted and anx- symptoms. Thus, children baptised far from ious appearance ; the spasm of the muscles, home, during a moist, cold season, are often at first insignificant, intermitting, and con- attacked; and, in Germany, physicians have, fined to the muscles of the jaw, becomes for a long time, made this interesting remore intense, and extends to the muscles of mark, that cases of tetanus abound in such the neck and back ; and the spinal column districts as are deprived of parish churches, is firmly fixed, or even bent backwards. In while they are much rarer in towns and this state the child may lay, apparently villages where the proximity of a church trauqnil, with the respiration a little acce- enables parents to have their children realerated, or it may be seized with violent and dily baptised. Diagnosis and Prognosis.—The peculiar repeated convulsions. In this latter case the face becomes tumid, and almost black ; cry and expression of the face, the trismus, the mouth is covered with foam; the arms contraction of the limbs and back, and, and legs are bent np; the fingers and toes above all, the coincidence of these sympcontracted. The spasmodic attacks occurtoms with inllammation or suppuration of every half or even quarter of an hour, and the umbilical chord, render the diagnosis are brought on by apparently insignificantof this disease extremely easy. Unfortucause.-!. After the lapse of twelve to twenty-nately, the prognosis is of a most unfavourfour hours the infant falls intoa state ofrable kind. Strong, vigorous children resist

720

somewhat longer than weakly infants, but cerebellum was in a state they all die. This is confirmed by the ex- ening. perience of all writers on this truly terrible (Thorax und Aldomen.) disease.

MORBID APPEARANCES.—We shall here at length, the results of twenty postmortem observations made by the author. Most of the bodies were examined thirtysix hours after death ; several from four to six hours after: and they were all enveloped in linen moistened with vinegar, and placed on the abdomen to prevent the gravitation of the blood. (External Appearances.) The face retained its characteristic appearance of suffering ; the muscular system, its rigidity ; and the fingers and toes were powerfully contracted. The umbilicus was surrounded by a large circle of a green or bluish-green colour. (Spinal Alarroiv.) The vertebral canal was opened in every case, and with extreme In four cases the spinal marrow and care. its membranes were free from any alteration. In the remaining sixteen an effusion of blood, in considerable quantity, occupied the whole length of the canal, between the bony walls and the dura mater. This blood was very dark in colour, sometimes fluid, at other times coagulated; in several cases it occupied more particularly a single region, as the cervical or dorsal, for ex-

repeat,

of

complete soft.

The viscera cotitained in these cavities, presented nothing worthy of notice. The lungs and heart On opening were commonly quite healthy. the abdomen, the stomach and intestines were also found in a normal state ; however, in five cases, some one portion of the intestinal tube was strongly contracted, while the- rest was much distended with gas. The umbilical arteries and veins were carefully examined in eleven cases, without any trace of inflammation or other lesion being discovered. The various nerves and their plexus were also healthy.

Treatment.—This was exceedingly varied. In most cases the antiphlogistic method was tried, but all the children died, even when it was employed with vigour from the very outset. The symptoms were alleviated for a short time, by lukewarm baths ; but whenever blood was abstracted, even 10. cally and in small quantity, they were evidently aggravated. About a dozen cases were treated, ineffectually, with musk, opium, and other antispasmodics. In one case, however, the use of these remedies seemed to protract the disease to the 31st

day.

On referring to Dr. COLLINS’ "Practical on Midwifery," lately published, Treatise ample :In nine of the sixteen cases the dura mafind the following remarks on the treatter and arachnoid were perfectly healthy. we ment of this disease, which fully confirm the The pia mater was evidently inflamed and of Dr. FtNCKH’s experience :-thickened in nine cases, and in three ’the results "With respect to the treatment, I have portion lining the posterior surface of the no suggestion to as I have never spinal marrow, was deeply congested. The seen an instance propose, where the child seemed substance of the spinal marrow was firm and normal in the nine cases accompanied even temporarily relieved by the measures Calomel has been tried by inflammation of its membranes; in the adopted. also in small doses often in large repeated, seven remaining, an effusion of blood, or of quantity, as well as extensive friction with mercurial a serous or gelatinous fluid, occupied the ointment. I have tried leeching vertebral canal. ,,the spinal column, also repeated blis(Cranium.) In only one case were the along contents of this cavity found exempt from terinn over its entire length. Opium I have alteration. In the other cases more or less exhibited in many ways, both in very large extravasated blood existed at the surface, or and small doses ; also tartar emetic in the manner, and at times both combined. in the interior of the brain. Thus, the effused same I have tried tobacco extensively, in the blood was found :form of stupes and injections of various de5 times on the surface of the brain. grees of strength, from one grain to the 5 --- in the plexus. ounce of fluid, to _five or more; besides the 3 in the lateral ventricles. frequent use of the warm bath, oil of tur2 under the pericranium. pentine, tincture of soot, assafoetida, and 1 at the surface of the cerebellum. many of the ordinary pargatives and stimu1 below the tentorium cerebelli. 1 above the tentorium. Here the lants; and all, as far as I could judge, without a shade of relief." P. 516. forceps had been used. As to the morbid appearances observed in The membranes of the brain were healthy, if we except more or less injection of their infants cut off by tetanus, Dr. COLLINS asvessels. In one case an effusion of ge- sures us that he was never able to discover latinous fluid, itistead of blood, was found morbid appearance which between the arachnoid and pia mater. The any peculiar substance of the brain, though commonly a would justify any explanation of the patho. little soft, offered nothing abnormal ; in two logy of this disease. This is a sweeping cases, however, it was very hard, while the manner of dealingwith a most interesting

frequent

’

"

721

important question, and we must pro- tunately the parents would not permit an of the body. against it with all our force. Dr. Cot.- examination The treatment consisted in warm baths, the to LINS should set a better example blisters over the region of the kidneys, and junior members of the profession, and fur- the administration of diuretics. Cases of nish, however briefly, the evidence upon this kind seem to depend (according to the which he grounds his general deductions. author) on paralysis of the kidneys from inWithout an observance of this essential rule terruption of the nervous influence. The disease is a most insidious one, and requires we can never hope to make any steady proattention on account of the appaparticular gress in the science of medicine for the sim- rent insignificance of the symptoms, which, ple reason that one assertion may be neutra- for many days, consist in nothing more than lized by another. Did Dr. COUINS examine dulness, weakness, and a pale appearance the spinal marrow in the thirty-seven cases of the countenance. Hence the physician and

test

which he mentions? Did he ascertain the cannot be too careful, in doubtful cases, of the condition of the urinary condition of the umbilical veins? From ascertaining Journal, Oct, 1836. system.—Hufeland’s our own reminiscences of the Dublin Lyingin Hospital, we should answer in the negaOF THE ABDOMINAL

ABSCESS

tive.

PARIETES.

PROTRUSION OF THE INTESTINES.

STRANGULATION.

CURE.

SUPPRESSION OF URINE FROM A 1IIILITARY surgeon was called in to atPARALYSIS OF THE KIDNEYS. tend a soldier’s wife, 72 years of age, the THE various cases of suppression of the messenger assuring him that the woman had

split her abdomen, and that her bowels were kidneys, show that all hanging out. He found the patient lying this is a highly dangerous affection. All on her back in bed ; the pulse almost imperof Sir H. Halford’s patients died in four or ceptible ; violent vomiting; about one-third five days. Haller, however, mentions a of the intestinal canal protruding. A few case of suppression which lasted twenty- days previously, a small furunculus had two weeks. Parr saw one of six weeks’ appeared on the left side of the navel : it became ripe, and opened : the woman was dmration. If we are to believe Vieussens, soon afterwards seized with a severe fit of a girl, eleven years of age, was affected coughing, during which the contents of the with complete suppression for eighteen abdomen were suddenly forced through the months. opening. The latter (about one and a quarDr. Boke, of Berlin, has seen a few cases ter inches in length) was too small to perof this affection. In two, it supervened on mit the return of the intestine. The surgeon, therefore, widened the orifice with a scarlatina; one of the patients died, very bistoury; returned the intestines; applied, unexpectedly, in a state of coma ; the other one or two stitches over the point, and was case we give in an abridged form. fortunate enough to save the patient’s life. A young child had passed through scar- —Caspar’s Wochen. 1837. No.8. latina, without any accident, and the desquemation of the skin was proceeding, when STYPTIC POWERS OF THE AQUA he exposed himself to cold in a chamber: SECALE CORNUTI AND BINELLI. the child now lost his appetite, became IN November, 1832, Dr. Müller divided weak and dull, and the face became somewhat swollen. He lay quietly on his back the popliteal artpry in two sheep, and then in bed, without fever; the tongue clean, applied a piece of lint to each, moistened, in thirst moderate; the bowels were opened one case, with the aq. binelli, in the other twice every twenty-fours, but the secretion with the aqua secal. corn. The hæmorrhage of urine gradually diminished, and finally was arrested in both cases, after the lapse became almost totally suppressed, the little of about six minutes : a similar result was patient passing only half a teaspoonful in obtained, after the same arteries were extwenty-four hours. The catheter was intro- posed a little higher up, and again divided. duced, for the purpose of ascertaining if The caudal artery of a horse was cut any urine was retained in the bladder, but through, and, while bleeding very freely, was the latter cavity was quite empty. The submitted to the action of the above-menchild was weak, flabby, and pale; only tioned substances ; the haemorrhage ceased urinary

secretion in the

spoke when addressed ; made no complaint ; the pulse was small, weak, and slow; thirst moderate. For the next five days the patient slumbered constantly; but the night before his death, which was sudden, became very uneasy, and had fits of suffocation, Unfor-

in

few minutes. The anterior crural artery the same horse, being also divided near its exit from the chest, the bleeding was arrested in eighteen minutes, with lint moistened in the aq, see. corn.—Klein. Repent., Dec., 1836, p. 79.

of

a