By Bert. Johnson, M.D., Eureka, Kan.
It is not. The purpose of this paper to present a treatise on the disease per se so much as it is to set forth the best known treatment and cure of the infection.
Tetanus will be found classed by some authorities under acute infectious diseases and by some under general and functional cerebral diseases. Ordinarily, I would think it best to assign it to the class of acute infections, but being asked by the Bureau of Nervous Diseases to write a paper and just having brought a case of tetanus through to recovery, I felt better qualified on that subject than any other nervous disorder, and found it more convenient to class it as such. For a nervous disease tetanus surely is. Its origin may be due to toxins produced by the tetanus bacillus, but the effect of those toxins are undoubtedly upon the nerve centers of the medulla and cord, afflicting the motor neurons chiefly. In the traumatic form of tetanus (which is the only form we are here considering) there is usually an ascending neuritis starting from the wound.
The incubation period is generally from ten to fifteen days following date of injury, but may be several months, and the first symptoms develop after wound has been healed for some time. Usually the longer the interval between the date of injury and the manifestation of the first symptoms, the milder the course of the disease and the better the chance of recovery. The mortality is high in any event, being given as ranging from eighty to ninety per cent.
The symptoms of tetanus being familiar to all physicians, not much will be said concerning them, and we will enter at once into the treatment, which in this day and age must needs be prophylactic first and curative after.
It is important to treat every wound from a more scratch or puncture to a deep, extensive laceration in an-extremely cleanly and antiseptic manner and, where there has been the least contamination with soil, to enlarge small and deep wounds, and keep well open with loose gauze packing saturated with either the hypochlorite solution of Dr. Carrel or the sodium citrate solution of Dr. Wright. These solutions promote drainage and render wound sterile in a few days far better than the ordinary antiseptics such as bichloride of mercury or carbolic acid, etc. Biochloride of mercury, by the way, is fast being discarded as a general antiseptic on account of the albumen, which is always present in the blood and tissues, rendering it inert.
In first cleansing a contaminated wound, if greasy, gasoline is a handy and efficient chemical to use and then follow up with hydrogen peroxide, potassium permanganate or other oxidizing agents, after which proceed to dress with gauze as before stated.
These gauze dressings must be renewed frequently for several days or until certain wound is sterile. But while doing all this, don’t forget the indicated homoeopathic remedy. You will generally find it among the following: Ledum, hypericum, Cicuta, Staphisagria, Arnica or Calendula.
I really place more stress upon the indicated homoeopathic remedy than upon all other treatment, the injection of anti-tetanic serum included. That there is some virtue in the serum we must admit, but that it excels or even approximates the indicated remedy in every instance, never. It may be the best combative means the Regular School have, but not the Homoeopathic School, and a combination of the two is poor practice. If the homoeopathic remedy is of no avail, then neither is the antitoxine. In desperate cases try any means within your power. “A drowning man grasps at a straw.” “It is not lack of faith, but lack of knowledge, that makes a man forsake the law in time of danger.”
You will find Hypericum most frequently indicated in these cases. “Injury to parts rich in sentient nerves, – fingers, toes, matrices of nails, palms, soles, – where the intolerable pain shows nerves are severely involved. Injuries from treading on nails, needles, tacks, pins, splinters; from rat bites; prevents lockjaw.” “Punctured, incised or lacerated wounds; sore and painful beyond appearances.” It is especially indicated in injuries evolving spinal cord and nerve.
Ledum comes next in frequency of indications and is some-what like Hypericum in that it is of use in injuries resulting from sharp instruments, awl, nails, rat bites, etc. The pains, however, are more sticking, tearing, throbbing and rheumatic; worse from warmth and better from cold and wounded parts are especially cold to touch.
Cicuta Virosa is more especially to be thought of in injuries from splinters in which spasms or truisms shortly result. It is more into the treatment than the prophylaxis that it enters.
Staphisagria is to be thought of in “mechanical injuries from sharp-cutting instruments, post surgical operations; the pains are stinging and smarting, like the cutting of a knife.”
Arnica would be given following traumatism in which the tissues have been contused as well as lacerated and Calendula in uncontested lacerated wounds. In injuries where suppuration is likely, Hepar sulphur, low, will often prevent such suppuration or, where it has already taken place, a high potency of Hepar sulphur or perhaps Silicea will hasten recovery and alleviate the suffering.
All this has to do with prophylaxis, but now suppose that, in spite of this, trismus of lockjaw develops or you are not called to the case at all until such symptoms are manifested, what then?
Well, first of all, keep cool. Don’t show the least ansiety or excitement for your patients is always very susceptible. Often the least touch, jar or noise, or even a draft of air, throws him into a spasm. The diagnosis is plain. If not, quietly get at the history of the case. As Dr. John B. Muphy has said, “The history often makes its own diagnosis.” The cardinal symptoms are an injury, even the slight, received ten or fifteen days previously, tonic or clonic spasms or the muscles of neck and face, rigidity of muscles of back and lower extremities and abdomen, with little or no rigidity of arms. The temperature is usually normal or under 100. There is often a good appetite, but marked constipation. Usually, one look at the countenance tells the talc – that wrinkled brow and sardonic grin! It is the first to appear in tetanus and the last in Strychnine poisoning. In both consciousness prevails throughout.
Now as to the treatment when tetanus is fully developed. Time is precious, delays disastrous. The patient should be put to sleep and the site of infection widely excised, pure carbolic acid applied followed with alcohol and alcohol compresses or dressings kept applied for several days. Have patient in a darkened, quiet, well ventilated room and attended by only one person the whole time. The diet should be liquid and, if trismus is marked, rectal feeding should be employed or feeding by a gastric tube through the nose. Action of bowels are best produced by high enema of normal saline.
Start giving the Homoeopathic remedy at once and keep it up at frequent intervals until improvement begins, then lengthen intervals of administration. Here, again Hypericu, Cicuta, Ledum come into use. Occasionally, Physostigma is indicated – “Spasms brought on by the slightest breath or air from a person passing.”
Magnesia phosphorica is another remedy highly useful and may be given along with another medicine without interference. To ease the painful spasms, I know of nothing better. Give it in the thirtieth or higher in hot water every five or ten minutesin severe and frequent spasms. At all time keep your patient as quiet and comfortable as possible. Allow no visitors. If called upon to administer anti-tetanic serum, and there seems no way out of it – do so and don’t be stingy with it. Often, public opinion is brought to bear upon you and the friends on relatives demand that antitoxine be used, so that if you don’t use it they will get some one who will, even though the case may be improving and doing as well as possible. People get impatient and want results quicker than is best or possible many times. They demand that you have consultation, and how often is it that we Homoeopaths in small towns’ can find another Homoeopath to call in? Very seldom, for usually there are none with reach and so it happens that the Regular man comes in. All he knows is serum. Well if you are forced to use it, do so under protest, but stick to your patient nevertheless. “God never loves a quitter.” Give the antitetanic serum and give it a plenty at frequent intervals. Begin with 5000 units at a dose. Inject subcutaneously into the abdominal tissues and near the site of infection. A better way, it is said, is to carefully inject without fear 20 cc. of the antitoxine directly into the ventricle of the brain, or do a lumbar puncture.
In injecting into the ventricle, anesthetize patient, shave scalp and, by means of a Doyen, burr an opening over the posterior end of second frontal convolution (Kocker’s point), pass needle and inject the 20 cc. In giving it subcutaneously, repeat at intervals of six or eight hours until decided improvement occurs, then double time between injection and gradually stop altogether. The serum always causes a decided reaction – a rise in temperature, drowsiness or restlessness. As high as 250,000 units have been given without any bad results.
To decrease spasms, the Regular School inject a 25 per cent. Solution of Magnesia sulphate with good results, but Magnesia phos. by mouth, to my notion, is to be preferred.
If improvement ensues, the patient shows it in a relaxation of muscles from above downward – jaw and facial muscles first, lower extremities last.
The writer has just successfully treated a case of tetanus in a poorly nourished, weakly looking boy of eight years of age. The history of the case is as follows:
On December 27th the patient ran a splinter from dirty kitchen floor in under nail of right index finger. It caused suppuration in a few days and much pain, but under simple home treatment got well in about eight or nine days except for the hail being loose. However, at just this time, nine days after injury to finger, the boy, who up to that time, except for pain in finger, had been feeling all right, now began complaining of his back and neck. Pain, stiffness of muscles of back and neck kept increasing until finally on the evening of January 10th, fourteen days following injury to finger, I was called in.
The boy was a perfect stranger to me and just my entrance into room threw him into a tetanic spasm. His jaw set, brow wrinkled and corners of mouth were drawn into a set grin. He was fully conscious, but only able to talk through his teeth. He seemed in great misery. His temperature was 100. There hardly was a relaxed muscle in his whole body except in his forearms.
Hypericum 500 in water was given him every two hours for five doses then only Sac. Lac. For a day. On the third day the Hypericum was repeated. There was just a slight improvement. On the fifth day of treatment Cicuta 6x (the highest potency I had) was given every hour and improvement was more rapid. Aside from-constant backache, the only pain the boy suffered was when tetanic spasms would set in, which, for the first few days, were frequent until I found that Magnesia phos. 30th, in hot water, at ten and fifteen minute intervals, soon allayed them and the convulsions came less often. Between such spasms his jaw and neck muscles relaxed and he could open mouth normally and eat all the family could get him. His appetite never failed. Anything unpleasant to taste, however, threw him into a convulsion.
Now comes “the rub.” With all this improvement, in the face of almost fatal odds – a disease of extremely high mortality, amidst noisy, crowded, filthy surroundings – the parents of the boy, urged on by neighbors and friends were dissatisfied and insisted that I call in consultation. This I did on the seventh day and my diagnosis was confirmed, but, of course, nothing except anti-tetanic serum was of much account. This has been so exploited by serum manufacturers and regular profession in general that thee laity have come to believe it the only treatment just as, with diphtheria, they can think of nothing but antitoxine, when Homoeopaths have been curing it for the past one hundred years with a mortality of only eight per cent.
In this case I protested my best, but finally, left it to the parents to decide and they decided in favor of the serum manufacturers, especially since the local boards of Associated Charities agreed to pay for the serum. My first impulse was to give up the case right then and there. After a night’s restless consideration, However, I decided to stay by the case in conjunction with the “Regular” but it was several days before I relinquished my Cicuta.
On the evening of the seventh day of treatment 3,000 units of anti-tetanic serum were administered subcutaneously into abdomen, followed every twelve hours with 5,000 units until 25,000 units had been given. For a few days after injection the boy seemed worse. Another “Regular” called in to see the case at this time, wisely shook his head and said, “The boy won’t live.” He had three cases in past ten years and lost them all in spite of the early administration of anti-tetanic serum.
A few days later decided improvement began. Gradually relaxation took place in the natural order of from above downward, and after he had received the 25,000 units, 24 hours was allowed between injections, of which he only received two more, making a total of 35,000 units. He made an uneventful recovery and was up and around on the 21st day following commencement of first treatment and 25th day following onset of the first symptoms.
In conclusion, I wish to state that I am firmly convinced that the Homoeopathic remedy alone would have cured this case, though I must, in this instance, give some credit to anti-tetanic serum.