The eponymous Dr James Marion Sims MD, LLD (1813-1883).

Dr James Marion Sims was born in 1813 in Lancaster County, South Carolina. It was while pioneering numerous surgical procedures in Alabama that in 1849 he achieved the outstanding landmark in medical history of successfully, and consistently, repairing vesicovaginal fistulae. Sims soon developed a reputation as a fine surgeon, with new operations and techniques, using novel surgical instruments and his innovative approaches frequently published. Moving to New York City in 1853, he further established hospitals devoted entirely to women's health. Sims was controversial, with flamboyant descriptions of self-confident success, yet they were tempered with sober reflection of failure and loss. Today we remain with the Sims speculum and Sims position, eponymous tributes to his accomplishments as the 'Father of Gynaecology'.

How World War 1 changed global attitudes to war and infectious diseases.

World War 1 was a key transition point towards scientific medicine. Medical officers incorporated Louis Pasteur's discoveries into their understanding of microorganisms as the cause of infectious diseases, which were therefore susceptible to rational control and treatment measures even in the pre-antibiotic era. Typhoid vaccination led to the successful evasion of the disastrous epidemics of previous wars. The incidence of tetanus was probably decreased by giving millions of doses of horse antitoxin to wounded soldiers. Quinine treated but could not control malaria; its use required mass compulsion. Tuberculosis was not a great military problem during World War 1, although mortality in civilian populations increased substantially. Treatment of sexually transmitted infections remained a matter of aversive conditioning, with invasive antiseptics used in the absence of antibiotics. Pandemic influenza in 1918-19 killed more people than died during the entire war, showing how much remained beyond the capability of the scientists and doctors who fought infectious diseases during World War 1.

Tetanus and the evolution of intensive care in Australia.

A review of two series of patients with tetanus from the Royal Adelaide Hospital provides a historical perspective on the evolution of intensive care in Australia. Nine consecutive severe cases presenting in 1957 constituted one of the first series published. Four patients died. The second series of 38 severe cases, among a total of 56 cases presenting between 1967 and 1985, included two deaths, comparing favourably with survival in other contemporary series. The specialty of intensive care evolved considerably during this time. Neuromuscular blockade introduced in the first series produced radical changes in management. Supportive measures that were not then widely practised, involving intermittent positive pressure ventilation, were used in the second series for up to 46 days and evolved into standard ICU practice. The option of using a tank respirator was rejected. Older patients were susceptible to complications commonly related to respiratory, cardiovascular and diabetic comorbidities, but most returned to their previous lifestyle. Severe tetanus often resulted from mild injuries in patients who were incompletely immunised. Four patients developed tetanus following surgical procedures. The use of nitrous oxide in the first series was abandoned owing to adverse effects on bone marrow function. Complications reported in early literature, such as fractures and myositis ossificans, presumably related to unrelieved spasm, are no longer seen. Clinicians are now likely to see the condition only if working with counter-disaster teams overseas.

A triumphant decline?: Tetanus among slaves and freeborn in Brazil / Um declínio triunfante?: Tétano entre escravos e livres no Brasil

Tetanus and other widespread endemic diseases of Brazil's early national period speak to intimate details of common life and give clues to big, vexing questions, such as why Brazil's population expanded dramatically at the turn of the twentieth century. Tetanus was for a long time one of Brazil's deadliest afflictions, especially among infants, but historians know very little about it. Using archival sources from across the Empire and early Republic, this article argues tetanus disproportionately killed the enslaved population, but gradually diminished in virulence for nearly all groups across the country by the second half of the 1800s. This decline should be attributed only partially to medical knowledge. Rather, indirect demographic and technological changes were more important factors in Brazil.

O tétano e outras doenças largamente endêmicas no período inicial do Brasil nação nos permitem entender pequenos detalhes da vida comum e grandes e inquietantes questões, tais como por que a população expandiu-se dramaticamente no início do século XX. O tétano foi uma das afecções mais mortais no Brasil, especialmente entre as crianças, mas os historiadores ainda conhecem pouco sobre ele. Utilizando fontes arquivísticas do Império e do início da República, este artigo argumenta que o tétano era desproporcionalmente severo entre a população escravizada, e que sua virulência reduziu em praticamente todos os grupos do país a partir da segunda metade do Oitocentos. Esse declínio deve-se apenas parcialmente aos conhecimentos médicos. Mudanças demográficas e tecnológicas indiretas foram fatores mais importantes no Brasil.

[The medical literature of the Egyptian campaign]. / La littérature médicale de la campagne d'Egypte.

Bonaparte's Egyptian Campaign (1798 - 1801), like all other episodes from the Napoleonic era, gave rise to an extensive literature on the subject, but most of all a significant medical literature. This fact is due to many reasons:--an important health service for this expeditionary corps of more than 36.000 men, with two main figures at its hea, Desgenettes and Larrey--but also with valuable subordinates like Assalini, Savaresi, Balme, Pugnet or Barbès.--A Commission for Science and Art, of which a few doctors and surgeons were members, but most of all pharmacists like Boudet or Rouyer--The presence in the field of Ludwig Frank, the nephew of the famous Johann Peter Frank.--The creation in Cairo of an Egyptian Institute and the publication of the masterly Description of Egypt and the establishment of printing houses.--The emergence of the myth of the Orient and its mysteries.--An extensive array of indigenous pathologies, which is characteristic of those countries. For instance: plague, dysentery, yellow fever, Egyptian ophthalmia, as well as more common diseases like tetanus, scurvy or venereal diseases. The main medical works that cover this period and its pathologies are skimmed.

Prevention of tetanus during the First World War.

The emergence of tetanus in wounded soldiers during the first months of the First World War (WWI) resulted from combat on richly manured fields in Belgium and Northern France, the use of modern explosives that produced deep tissue wounds and the intimate contact between the soldier and the soil upon which he fought. In response, routine prophylactic injections with anti-tetanus serum were given to wounded soldiers removed from the firing line. Subsequently, a steep fall in the incidence of tetanus was observed on both sides of the conflict. Because of fatal serum anaphylaxis associated with administration of serum at a time when purification methods still needed to be improved, it must be presumed that tens to hundreds of men might have died as a result of the routine administration of anti-tetanus serum during WWI. Yet anti-tetanus serum undoubtedly prevented life threatening tetanus among several hundred thousands of wounded men, making it one of the most successful preventive interventions in wartime medicine. After the abrupt fall in tetanus incidence in 1914 due to introduction of anti-tetanus serum, the incidence of the disease tended to become even lower as the war went on. This was probably due to earlier and more thorough surgical treatment, consisting of opening, cleaning, excision and drainage of wounds as early as possible. In this overview, recent battlefield findings from the Meuse-Argonne offensive in 1918 are used to illustrate common practices employed in the prevention of tetanus during WWI.

A triumphant decline? Tetanus among slaves and freeborn in Brazil

Tetanus and other widespread endemic diseases of Brazil's early national period speak to intimate details of common life and give clues to big, vexing questions, such as why Brazil's population expanded dramatically at the turn of the twentieth century. Tetanus was for a long time one of Brazil's deadliest afflictions, especially among infants, but historians know very little about it. Using archival sources from across the Empire and early Republic, this article argues tetanus disproportionately killed the enslaved population, but gradually diminished in virulence for nearly all groups across the country by the second half of the 1800s. This decline should be attributed only partially to medical knowledge. Rather, indirect demographic and technological changes were more important factors in Brazil. (AU)

La alferecía y los primeros casos de tétanos neonatal descritos en Chile en 1894 / Alferecía and the first cases of tetanus neonaturum described in Chile in 1894

Federico Puga Borne presented the first two cases of known Chilean tetanus neonatorum in 1891. These cases had a fatal course, were poorly described and had no necropsy. The presentation was done in a regular session of the Sociéte Scientifique du Chili, founded in 1891 by a French citizen settled in the country, and published in the Actes de la Sociéte Scientifique du Chili. At this time, tetanus had never been seen in a newborn in Chile, while it was very common in other South American countries; its popular name was alferecía, but this term covered many other neurological disorders.

Se reproducen in extenso los dos casos de tétanos neonatal presentados como los primeros descritos en Chile por Federico Puga Borne en una reunión de la Societé Scientifique du Chili, sociedad fundada en 1891 por ciudadanos franceses, cuyo órgano de expresión Actes de la Société Scientifique du Chili apareció hasta 1938. Aimbos casos fueron fatales, no tuvieron autopsia y están pobremente descritos. En la reunión se comenta la rareza de esta patología en Chile, a diferencia de su alta incidencia en los países vecinos, y se menciona que el pueblo la conocía con el nombre de alferecía, que parecía reunir diversas afecciones neurológicas.

"No doubt this childhood disease on Vestmannö can be prevented"--neonatal tetanus on the Westman Islands.

At the beginning of the 1800 s neonatal tetanus was a major health hazard on the Westman Islands, an archipelago immediately south of Iceland. Up to 60­70% of newborn babies died in the course of the first two weeks of life, and Danish health authorities were almost helpless in the face of this mysterious disease. In 1847 the young Danish doctor Peter Anton Schleisner (1818-1900) was sent to the islands to investigate the conditions there. He established a maternity hospital, gave advice on hygiene and encouraged breast-feeding and a number of changes in diet. Since there was no known treatment, Schleisner's only option was to resort to preventive measures. He dressed the umbilical stump with balsamum copaivae and tried well-established methods such as opium tincture with saffron and mercurial ointment if there was any sign of infection. By the time he returned to Denmark after nine months, mortality had been halved. Neonatal mortality on the Westman Islands remained at the same low level throughout the rest of the 19th century. According to popular belief this was due to the naflaolian (navel oil) which Schleisner introduced. Nevertheless, it can be partly attributed to generally improved living standards, a relatively higher number of mothers in better social circumstances, a greater urban influence, changed lifestyle and hygienic measures. Schleisner's efforts are considered to have had major significance when conditions are compared with those on the Scottish island of St Kilda where the situation was the same and improved only just before the turn of the century.

El tétanos en España. Estudio de la mortalidad a lo largo del siglo XX hasta la actualidad / Tetanus in spain. Mortality study along the XX century to the present

Con el presente estudio se pretende poner de manifiesto la gravedad de una enfermedad prácticamente erradicada hoy gracias a la vacunación – el tétanos– pero que supuso una elevada mortalidad durante gran parte del siglo pasado(AU)

The present study aims to highlight the severity of a disease now almost eradicated through vaccination, tetanus, but that was a high mortality during much of the last century(AU)

[Neonatal tetanus--an explanation why the slaves in the Danish West Indian Islands not were self-sustaining]. / Neonatal tetanus--en forklaring på slavernes manglende reproduktionsevne i Dansk Vestindien.

The sugar plantation complex in West India was based on forced labour, mostly slaves from Africa. The problem was that this population had to be sustained by a constant stream of new slaves just to maintain their numbers. This demographic imbalance has during generations puzzled scholars and doctors. Modern research, however, shows that the fertility rates were normal. The problem was the infant mortality. The slaves' cultural tradition concerning childbirth had fatal consequences by being transferred to West India, where many newborn slave children died of neonatal tetanus.

[Alferecía and the first cases of tetanus neonaturum described in Chile in 1894]. / La alferecía y los primeros casos de tétanos neonatal descritos en Chile en 1894.

Federico Puga Borne presented the first two cases of known Chilean tetanus neonatorum in 1891. These cases had a fatal course, were poorly described and had no necropsy. The presentation was done in a regular session of the Sociéte Scientifique du Chili, founded in 1891 by a French citizen settled in the country, and published in the Actes de la Sociéte Scientifique du Chili. At this time, tetanus had never been seen in a newborn in Chile, while it was very common in other South American countries; its popular name was alferecía, but this term covered many other neurological disorders.

A unique experiment in neurological surgery: intracerebral injection of antitoxin for tetanus.

The discipline of neurological surgery was considered primarily "hopeless" and, at best, experimental in the late 19th century. Harvey Cushing's efforts during his initial uncharted voyage through the surgery of the human cranium were rudimentary and exploratory. A direct review of his available patient records from early in his career provides the opportunity to look back at Cushing as a physician-scientist, uncovering work that demonstrates that he was at the forefront of neurosurgical intervention in avenues that have been largely overlooked. The authors present Cushing's notes pertaining to a case of tetanus. This case represents the intersection of neurosurgery and tetanus treatment in Dr. Cushing's intracerebral injection of antitoxin to treat generalized tetanus.

Some prehistory of New Zealand intensive care medicine.

In taking 1960 as the foundation year for the practice of intensive care medicine in New Zealand, this paper briefly looks into the previous two centuries for some interventions in life-threatening conditions. With the help of descriptions in early 19th century journals and books by perceptive observers, the author focuses on some beliefs and practices of the Maori people during pre-European and later times, as well as aspects of medical treatment in New Zealand for early settlers and their descendents. Dr Laurie Gluckman's book Tangiwai has proved a valuable resource for New Zealand's medical history prior to 1860, while the recent publication of his findings from the examination of coroners' records for Auckland, 1841 to 1864, has been helpful. Drowning is highlighted as a common cause of accidental death, and consideration is given to alcohol as a factor. Following the 1893 foundation of the New Zealand Medical Journal, a limited number of its papers which are historically relevant to today's intensive care are explored: topics include tetanus, laryngeal diphtheria, direct cardiac massage, traumatic shock, thiopentone management for fitting and the ventilatory failure due to poliomyelitis.