388 GENERAL NEUROSES, OF UNKNOWN ANATOMICAL ORIGIN. 



patient may even enjoy a brief refreshing slumber, should not be 

 allowed to deceive us. After such pauses the malady generally breaks 

 out with all its former severity, or even with increased violence. We 

 must not indulge in the hope of recovery unless the seizures continue 

 to diminish in length and frequence, distinct relaxation of the con- 

 tracted muscles occurring during the intervals, and unless the patient 

 become able to take food and nourishment. Even in the most fortu- 

 nate cases this takes place with extreme slowness ; and it is not until 

 after the lapse of weeks that the muscles entirely lose then- tension, 

 and the patient is completely well. 



The symptoms of tetanus neonatorum are but little modified by the 

 peculiarities of the infantile organism. Here, too, the outbreak of the 

 disease usually is heralded by indistinct prodromata. The child cries 

 out frequently during sleep ; has blue rings around the eyes and lips ; 

 and lets go the breast which it has just seized with avidity. The 

 mother first becomes aware of the onset of the disease itself when she 

 finds that neither the nipple nor the finger can be inserted into the 

 mouth. The jaws stand several lines apart, but it is impossible to 

 separate them further. The malady increases rapidly. The muscles 

 of the face are also contracted spasmodically. The forehead is wrin- 

 kled, the eyelids firmly shut, and surrounded by converging wrinkles. 

 The alae nasi are dilated, the lips compressed and puckered, while the 

 tongue usually is fixed between the jaws. Besides this, there is opis- 

 thotonos, the head is drawn backward, and the spine arched like a 

 bow. A touch, or an attempt to move or swallow, provokes a violent 

 spasm ; but the remissions usually are more complete than they are 

 in the tetanus of adults. Respiration is impeded, during the seizures, 

 by the rigidity of the thorax and the tension of the abdominal mus- 

 cles. Attacks of suffocation arise, of which the child often dies in 

 from twelve to twenty-four hours. In other cases the breathing grad- 

 ually becomes insufficient, and the child succumbs to overcharge of the 

 blood with carbonic acid. Death then takes place more slowly, but 

 still within a few days, during which the child loses flesh rapidly. 

 Recovery from tetanus neonatorum' is likewise extremely rare. 



TREATMENT. For the fulfilment of the causal indication, a series 

 of surgical operations even amputation of the wounded member 

 have been proposed and practised. The success of these operations, 

 however, was by no means what had been anticipated of them, and 

 more recently they have been abandoned. From the prominent part 

 which is unmistakably played by exposure to cold, both in rheumatic 

 and in traumatic tetanus, warm and stimulating baths, as well as Russian 

 vapor-baths, would seem to be indicated. The objection, that the 

 manipulation necessary in giving such baths tends to aggravate the 



