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.

    16/18 (page 10)
    In my own case a most careful investigation was made to exclude the possibility of its being merely a coincidence due to independent causes, and tbe absence of middle-ear disease, intracranial growths, brain abscess, etc., were thoroughly demonstrated. In the present stage of our bacterial knowledge it seems much more rational to refer it to a direct toxic effect of the poison acting upon the filaments of the seventh and fifth nerves rather than to a cold, rheumatism, etc. I have succeeded, with the kind assistance of Dr. Alfred Hand, Jr., in collecting 75 cases of cephalic tetanus ; 57 males and 13 females are noted. In 45 acute cases (counting those acute ones in which the symptoms have developed within the first weekj, 39 died and only 4 recovered ; a mortality of 90 per cent. Of 32 chronic cases (where the symptoms arose after the first week), 8 died and 24 recovered ; a mor- tality of 25 per cent. Gowers states that all cases over 25 years of age died ; but my table shows that of acute cases (one week) there were 2 recoveries in 32 cases in persons over that age, and 13 recoveries in 15 persons who were classed as of the chronic variety. Under 25 years, in 12 acute cases there were 2 recoveries, and in 16 chronic cases, 13 recoveries. In the 75 collected cases when the spasm extended to the muscles of the jaw, throat, and neck they have been denominated local; while if opisthotonos and spasm of limb muscles occurred they were denominated as general. There were 29 cases of the former condi- tion and 46 of the latter. Of the local cases, 14 recovered and 15 died ; while of the general, 14 recovered and 32 died. In this form of tetanus, as well as in general tetanus, the actual mortality is far higher than statistics will indicate, as in my personal experience I have certainly seen twenty deaths from tetanus to one of recovery, and j^et none of the twenty fatal cases are on record.