(Reprinted fromTHK I'HIt.ADKI.PIIIA Pol.Yl l.lNir,Vol. IV, AHKimt 24, iHq.v No. 34, |

TETANUS NEONATORUM.W. A. NKWMAN DORI.ANI), M I).

liiNtmctor In Gynecology, Philadelphia Polyclinic.

Tetanus of the new-born child is of suchan infrequent occurrence that more than theordinary degree of interest is necessarily cen-tered in any given case. Not only is thisdue to the rarity of the disease, but also ourcomparative ignorance of the pathology andcausation thereof renders any accurate rejiorlof a case doubly interesting as jiossibly aid-ing in elucidating these obscure questions.Thanks to the valuable labors of the pioneers,Beumer and Peipcr, and their followers, weare to-day in a position tostatc definitely thattetanus, whether occurring in adult, child orinfant, is one and the same disease, but inwhat its precise pathology, macroscopic andmicroscopic, consists; as to the method ofworking of its specific germ or poison ; itsmode of entrance into the system ; and whyit should be of such rare occurrence in thenewly-born ; these are all questions that haveperplexed and still arc agitating the minds ofmany. Even a brief review of the theoriesand arguments advanced in regard to thesepoints would far outreach the scope of thisshort report. We do know, however, that itis most frequently the offspring of the indigentand untidy that are affected, and that thechildren of the colored race are much moresubject to it than are their lighter complex-ioned fellows. It apjiears to occur irres|>cc-tive of climatic influence, anti so far as wearc able to state would seem to be mainly asequel of some form of traumatism associatedwith septic infection often of obscure origin.The open wound of the umbilical would

certainly afford ample entrance to septic germsin infants improperly cared for, and in thecase now to be reported it was very probablyhere that the disease originated.

On the evening of the 25th of July, thewriter was hastily summoned to a tenement-house to sec a “ very sick baby.” In a small-sized bedroom in the upper story, containingtwo beds and presenting more than the usualdegree of untidiness, there was found a well-formed female colored child, six dajs old,who presented the following history and symp-toms : The child was born at 1 o’clock, onthe morning of July 19th. The woman wasattended by a colored midwife, who statedthat so far as sheknew everything in the con-finement had been normal, and that she hadgiven special attention to the dressing of thecord. The child had taken the breast at reg-ular intervals, and apjieared absolutely welluntil the morning of the fifth day, when itdeveloped an extreme degree of restlessness,refused the nipple and seemed to lie in pain,as evidenced by constant crying. The motherhad noticed that at this time it had developeda moderate amount of fever, and on attempt-ing to introduce her finger into its mouth shehad found it utterly inqtossible to do so onaccount of the rigidity of the jaw’s. Its condi-tion had progressively grown worse until theevening of the next day, when the physicianwas sent for.

lJ|>on stripping the infant, the followingnotes were made: The child lay upon itsback with tightly-closed eyes and puckered

Ups, the latter being deeply cyanosed. Therewas considerable distention of the abdomenand some pouting of the umbilicus. Onsuperficial examination the wound left by thedropping of the cord appeared to lie almostcompletely cicatrized and presented an al«o--lutely healthy appearance. The limbs werestrongly contracted upon the body, assumingthe normal position of the limbs in the fetalellipse, and resisted efforts at straightening.At this time it was noticed that drawing thefinger lightly over the distended abdomen wassufficient to throw all of the muscles into astate of spasmodic contraction. The bowelswere slightly costive. A doubtful prognosiswas given. The child was fed by gavage,the milk—i or 2 drams every hour—con-taining a couple of drops of whisky. Onegrain acetanilid powders were administeredevery two hours as a nervine and antipyretic ;

the bowels were opened by enema, and aspice-poultice was placer! over the enlargedand tympanitic abdomen. Notwithstandingthese efforts, the child progressively grewworse through the night and died the nextmorning—the seventh day after birth. Just

before death supervened there occurred anoozing of blood from the umbilicus and amore profuse bleeding from the nose andmouth. 'The nervous tension of the childbecame so extreme during the morning that,the mother said, a loudly spoken word or alaugh was sufficient to induce a violent con-vulsive seizure. A post-mortem examinationwas refused.

It is impossible to state absolutely whatwas the origin of the infection in this case.That it occurred through the umbilicus isvery strongly indicated by the slight ompha-lorrhagia that was noted immediately priorto death. The essential conditions of filthand poor hygienic surroundings were present,and delivery by a colored midwife is pre-sumptive evidence of further lack of anti-septic precautions. As is usual in these cases,there was no response to treatment. It wouldl>e interesting to know what would have re-sulted from the administration of the anti-toxin of Tizzoni and Cattani. Whether thishas as yet been employed in the treatment oftetanus neonatorum the writer has not beenable to determine.

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