A CASE OF TETANUS -TREATED BY

BACELLI'S method in conjunction WITH ANTITETANIC SERUM.

By J. CRAWFORD BOYD,

liegt., i.m.s.

The following is a short history of the case before the tetanic symptoms developed.

Patient, a syce, aged 35, was admitted to

hospital on the 16th June 1910, suffering from a punctured wound situated near the vertebral border of the right scapula and which he states was caused by the fall of a pickaxe. The examina- tion of the wound showed that it was stuffed with some black substance (called, I believe, by the natives Missee, a preparation of ferrum galls, etc.). The margins of the wound were inflamed and unhealthy looking. Pulse and temperature were normal. Antiseptic fomentations were ap- plied and the wound drained. This treatment was carried out until the 2/th June when unfoitu-

nately the patient ran away from hospital and

no more vvas heard of him till the night of tlm

29th when he was found lying hi the^lines and

again brought to hospital. On his second ad-

mission he presented the following signs and

symptoms of tetanus, well developed trismus ami

risus sardomcus, dysphagia and slight opistho-

June 3Oth, 1910-?The treatment adopted was first i?n ianon in as quiet a room as possible to try and a ?>

irritation, after which the wound was incised in two?dr

three directions and thoroughly purified, 20 ccs anfcifcp

tnnic serum were injected into the subcutaneous 'tisane of the lumbar region and large doses of bromide nf

potash were given internally. Nourishment in the form

of milk and eggs was also administered.

July 1st. The condition of the patient seemed better

as he was ab'e to take a little nourishment and tl?

opisthotonus was not so marked. Another 10 ccs of

antitetanic serum were given with the subcutaneous

(issue of the abdominal wall, and large doses of bromida of potash were also prescribed. He passed an unsatis

factory night. July 2nd.-The patient

was worse, the spasms having

again increased in frequency and duration Another

10 ccs of antitetanic serum weregiv.n into the abdominal

wall and I also determined to try the effects of subcu

taneous injections of carbolic acid. The solution used wiJ

a 3% sol. of phenol, 29635 minims = i gramme Pu?e

phenol. Of this solution he was given altogethe? in the 24 hours 210 min., 20 minims

at a time being injected

into the cellular tissue of the subclavinian region bv

means of a hypodermic syringe and at intervals of from

1| to 2| hours. The patient did not seem

to suffer any pains or in-

convenience under this treatment, and the solution in-

jected was quickly absorbed. The urine was carefully

tested before the treatment

was commenced ; no albumen was present.

July 3rd?The condition of the patient was improved

the spasms had become less and he was able to take'

some nourishment; urine was tested, nothing abnormal

being found. Phenol sol. amounting to 210 minims

again given. July 4th?Patient

was able to speak a little and took

his nourishment well. Spasms had 'almost disappeared urine normal. 300 minims of the carbolic solution' injected. July 5th? Improvement

still continuing. Urine nor-

mal, 200 min. of the solution given, one dose was

given into the subcutaneous tissue of the arm ? this

seemed to give the patient some pain and discomfort

and took a long time to absorb.

July 6th.?Urine normal, 200 mins. given.

July 7th.?Urine normal, 200 mins administered

July 8th Urine normal. Except for the risus

sardomcus symptoms all disappeared.

July 9lh-In the morning the patient suddenlv rnl

lapsed and died from heart failure before anything

could be done for him. anjunng

Remarks .?According to statistics if the incu- bation period is from 11 to 13 days the percent-

age of recoveries is about 27 per cent. ; probablv

therefore, this case was not a particularly <rood

one to judge the effects of Bacelli's treatment on Lhe treatment was also not supplemented by pro-

longed hot baths or by the administration of

paraldehyde as recommended. Mayer and Ransom have shown that the period

of incubation depends to a large extent on the

length of the nerves to the contaminated area

lhe virus being taken up by the nerve motor end

plates probably by means of centripetal action

ot the protoplasm (Bosanquet) ; why therefore

138 THE INDIAN MEDICAL GAZETTE. [April, 1911.

considering the length of the nerves of tliis^ region the incubation period was not shorter is hard

to say. Possibly it may have been due to some

attenuation of the virus brought about by the

preliminary antiseptic treatment of the wound. The above authorities have also shown that

antitoxin introduced intravenously does not save

ail animal's life if the tetanus toxin is introduced

into a nerve, and they attribute it to the fact that antitoxin can only neutralise the toxin in the blood. If this is so, perhaps the subcutaneous injection of a phenol solution in the neighbourhood of the

wound may prove a helpful adjunct in the treat-

ment of this disease, and I would suggest that the first few injections of tho solution should be

so given.

Up to^tlie present in nearly all the cases report-

ec on as treated by phenol injections the result has

een satisfactory, especially as regards the allevia-

lon ^ y the symptoms, and though the above

case

eiminated unfavourably, I do not think it was in

.eveiy way due to the treatment adopted as no

signs ot phenol poisoning were at any timeexhibit-

' 6l'

.

0 other hand, I would say that the

ame loration of the patient's symptoms was largely

due to it, though why phenol (C.H.O H) not even

-,S0 au ^cid, though capable of forming a salt,

ri u11!11'0 or destroy the tetanus toxin, is

aimoult to understand.

References : ?

British Medical Journal, December 11th, 1909.

i: '.-Lancet, October 16th, 1909. Medical Annual, 1909-1910,