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Tetanus in Brazil


Opisthotonus, Charles Bell

Tetanus has become the latest focus of the EE project.  This disease is usually the result of a wound infected by the Clostridum tetani bacteria.  As this microbe multiples it release a neurotoxin that can quickly become fatal if untreated.  Poisoning is accidental, since the nuerotoxin is a natural byproduct of its life cycle.  It is a terrible accident, though, since it causes spasms and tightened muscles, especially around the jaw (hence its older popular name "lock-jaw") and  back (called opisthotonos, see image).  One of its most tragic manifestations is neonatal tetanus, usually due to an infection at the umbilical stump caused by a dirty cut or contaminated poultice.  In some parts of Brazil as many as one out of three infants died from neonatal tetanus.   Millions of mothers and fathers watched their newborns stop feeding and arch in pain for days before dying.   

I have only just begun to look at the data, but so far I have found a large drop in in the incidence of neonatal tetanus around 1890 in some parts of Brazil, right around the time that European and Japanese doctors discovered and isolated the tetanus bacteria.  As the same time, there are still a sufficient cases of neonatal tetanus in the early 1900s, indicating that asceptic practices were uneven.  What fascinates me about this disease is how connected it is to medical practice and belief.  By understanding the history of tetanus, we will have a much better idea of how foreign medical knowledge disseminated in Brazil and how quickly medical and midwifery practice changed.  A fuller description of this research can be found here.

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