As met with after abortion or labor at term, tetanus presents no special peculiarities in course, treatment, or termination. Of very rare occurrence in temperate regions, it is often met with in hot countries in women of the darker-colored races. Grief, anxiety, overwork, and profuse hemorrhage predispose to it, as do obstetrical operations and the retention of pieces of the placenta. Unlike the ordinary puerperal affections, it is more common in the country and in private practice than in cities and hospitals. Rather elderly women are more often attacked than are those younger. First and second pregnancies are the more dangerous if completed; later ones if abortion occurs. Abortion in the earlier months, especially in the third, is most likely to be followed by the disease (Garrigues). Ordinarily manifesting itself within ten days after labor, it has been known to occur after an interval of a month.
Hysteria, eclampsia, and especially tetany, may be mistaken for it. The latter affection, which generally attacks young women, may occur at any time during pregnancy or lactation—tetanus only within a comparatively few days after delivery.
Its TREATMENT is the same as that of ordinary tetanus, care being taken to remove from the uterus as speedily as possible any contained foreign body. Antiseptic irrigations may prove of service, though it is doubtful if their employment can accomplish much after the commencement of the spasms. Aveling has thought that transfusion might perhaps be of benefit.
The occurrence of intracranial congestions, hemorrhages, and venous thrombosis21 will, almost of necessity, render any medication of no value.
21 Such as were found upon autopsy in the case reported by Macdonald, and believed by him to be the essential lesions of the disease.
Under all circumstances the PROGNOSIS is exceedingly grave. The mortality-rate of the cases after abortion collected by Garrigues was 92 per cent. (25—23), and of those after labor 84.37 per cent. (32—27).22
22 As indicating the extreme gravity of tetanus occurring in connection with a wound of the genital tract, it may be noticed that of 17 cases after ovariotomy collected by Parvin, 16 died, 94.1 per cent., and of 24 cases tabulated by Olshausen, 23 died, 95.83 per cent.
Tetanus Neonatorum.
From the earliest times it has been known that newly-born children are occasionally the subjects of trismus and generalized spasms, and that those thus affected usually die.
More common among the darker races23 and in warm countries (though some of the southern races and tribes are almost or altogether free from it), it has been for years together endemic in places far north (e.g. the islands of Heimacy and St. Kilda), and a veritable scourge in certain lying-in hospitals (e.g. Dublin, Stockholm, St. Petersburg). Occasionally it has prevailed epidemically.