Ferdinand von Mueller

1

Letter not found. For the text given here, see ‘Treatment of tetanus by hypodermic injection of nicotine’, Australian medical journal, December 1876, pp. 379-80. The item is introduced by ‘The Hon. Sceretary read the following communcation on the above subject from Dr. E. M. Wuth, surgeon of the Burdekin and Flinders district [Qld], which had been placed at his disposal by Baron von Mueller:’. Wuth’s letter is dated to November 1876 as the latest likely it could have been sent to reach M in time for it to be read at the meeting of the Medical Society of Victoria on 6 December 1876.

I have here the pleasure of recording to you a second case of successful subcutaneous injection of nicotine (two drops to the ounce,

2

Footnote inserted by Editor: ‘Dr. Wuth does not state the quantity injected at a time’.

at the height of the symptoms two injections twice a day), and this time on the person of a middle-aged strog Chinaman. A month before the complaint set in, patient was struck by the handle of a well on the forehead, and received a scalp wound. After the wound had healed, trismus set in; then stiffness of theneck, followed by opisthotonos, with convulsive movements of the body. He remained in the same condition when entering the hospital, with the addition that the left thigh also got affected: and although the injections had to be continued for a week, the disease got arrested, and by degrees vanished under the remedy. The effect was not so decided (almost marvellous) as in the case kindly read by you before the Society in September 1871;

3

Wuth (1871), ‘communicated by Ferd. Von Mueller, M.D., F.R.S., C.M.G.’.

yet no other remedy to my knowledge has shown such a specific effect in tetanus. In this case, as in the former, there was drowsiness or sleep after the injections; and whilst the jaw was the first part to show rigidity, their muscles relaxed the first after the first injection. This is a most important fact, as facilitating the patient being nourished by the mouth.

On the fourth day after entering our hospital, all convulsive spasms had ceased, but rigidity of muscles remained, as stated above, for a week. The patient now opens his mouth to an inch, moves his head in all directions, can bend his back and enjoy the sitting posture, but as in my first case (‘what has the doctor done with my thigh? I feel all benumbed’) also this patient complains of great weakness in the thighs, yet he can raise them.

In this country the general place for hypodermic injections is the thigh; yet in Germany I see they like, if practicable, to inject near the affected place; and I have persuaded myself in the present case, that more especially nicotine injected hypodermically, has besides the general, also a most decided local effect in its application. Liebig’s extract of meat, milk, and egg were given for nourishment; but no stimulants were administered. I would, however, not hesitate doing so if there were danger of dissolution.

Now, my two cases show that the effect of the remedy employed is most decided and lasting, a quality hitherto not observed by all the other remedies employed. Would it therefore, in the interest of our profession, be too much to ask you to mention this latter case before your Society.

4

The article continues:

To this communication Baron von Mueller added [B76.12.05]: I have great faith in physostigma venenosum as a remedy in tetanus; but perhaps the calabar bean is not always so readily to hand as nicotine.

It is a curious fact that Orfila, in his experiments with dogs, produced “convulsions, which rapidly passed into a tetanic state, with opisthotonos,” by administering nicotine. Van Praag sume up the effect of nicotine as follows: “It primarily lowers the circulation, quickens the respiration, excites the muscular system; but its ultimate effect is general exhaustion,” the respiration being gradually reduced under the influence of nicotine. The anomalies above alluded, to are explained by the observations of Kölliker and others, who found “the muscles in part affected with alternate tonic and clonic spasms, general relaxation succeeding to these, with a tremulous movement of particular muscles, or the whole body.” Or in using larger doses of the alkaloid, as quoted by Stille, “immediate and complete prostration” may follow, which may prove fatal. The beneficient action of nicotine in trismus must therefore depend on a judicious control of the quantity used. The application of nicotiana in tetanus is not new, particularly tobacco as enema. It would be interesting if the superiority of nicotine over aconitine, atropia, and morphia for hypodermic application could be established, not only against tetanus, but perhaps also hydrophobia, when chloroform, or physostigma, or ice fail.