J.M.K. Spalding

INVOLVEMENT OF THE SYMPATHETIC NERVOUS SYSTEM IN TETANUS: Studies on 82 Cases

Abstract Retrospective studies are described on a series of 82 patients with tetanus, 44 of whom were treated by tracheostomy, curarisation, and intermittent positive-pressure ventilation. Patients with severe tetanus may develop a characteristic syndrome whose features include sustained but labile hypertension and tachycardia, irregularities of cardiac rhythm, peripheral vascular constriction, profuse sweating, pyrexia, increased carbon-dioxide output, increased urinary catecholamine excretion, and, in some cases, the late development of hypotension. It is argued that this syndrome may be due to continuous but fluctuating overactivity of the sympathetic nervous system.

TREATMENT OF SYMPATHETIC OVERACTIVITY IN TETANUS

Abstract Treatment directed towards suppressing sympathetic overactivity was assessed in four patients who had profound circulatory disturbances during severe tetanus. Chlorpromazine did not provide satisfactory control of these disturbances, and prolonged general anaesthesia, although otherwise successful, was limited by the potential toxicity of the agents used. A combination of propranolol and bethanidine was used in three patients to block adrenergic effector mechanisms, and proved satisfactory in controlling the hypertension, tachycardia, and cardiac dysrhythmias.

TEMPERATURE REGULATION IN SURVIVORS OF ACCIDENTAL HYPOTHERMIA OF THE ELDERLY

Abstract Eight survvivors from accidental hypo- thermia of the elderly, and three elderly controls who were not known to have had hypothermia were examined. Central and superficial body tempera- tures, shivering, hand blood-flow or finger heat elimina- tion, blood-pressure and, in three survivors and the controls, oxygen consumption were recorded when the subjects were comfortably warm and when their skin was cooled with a fan. The controls showed responses similar to those of younger healthy individuals. The survivors resting central temperature was low. On exposure to cold it fell progressively and abnormally. Evidence is presented that this is due ti impairment of the increase in heat production and decrease in heat loss normally evoked by exposure to cold. This abnormality of body temperature regulation is probably a major aetiological factor in accidental hypothermia of the elderly. It was present as much as 3 years after recovery from accidental hypo- thermia of the elderly, and survivors from accidental hypothermia of the elderly therefore must be regarded at risk from another episode of hypothermia when exposed to only moderate cold.

Cardiovascular disturbances in severe tetanus due to overactivity of the sympathetic nervous system

I n a previous communication1 based on a retrospective study of 82 cases of tetanus, it was postulated that overactivity of the sympathetic nervous system could account for many features of the disease which cannot be explained on the basis of hyperexcitability of motor neurones. It seems likely that some of these features, in particular the severe cardiovascular disturbances, contribute to the still considerable mortality and morbidity of the disease. This paper describes physiological observations on six patients with severe tetanus treated with curare and intermittent positive pressure ventilation (IPPV). The findings support our previous suggestion that overactivity of the sympathetic nervous system is an integral part of severe tetanus.