Tetanus may be mild, moderate, severe, or inevitably fatal. Our clinical experience suggests it may be classified as severe (or, maybe, inevitably fatal) when a tetanic spasm stops respiration. Ten patients with severe tetanus were treated by the total paralysis regime (T.P.R.), consisting of tracheostomy, curarization, and intermittent positiveor positive/negative-pressure respiration. Two of the patients were saved by T.P.R. and therefore only limited effectiveness can be claimed for the regime. In inevitably fatal cases survival can be prolonged by T.P.R. so that further effects of tetanus toxin emerge. Of these, the most important appears to be direct damage to the myocardium.
I would like to report the case of a Chinese boy of 5 years old who came to see me with a ball-bearing in one of his ears. Repeated attempts were made to extricate it under general anaesthesia by means of several kinds of aural apparatus, but they all failed. While about to give up hope and hand him over to a specialist, I managed to borrow a pair of magnetic forceps from a radio mechanic. The ball-bearing was immediately attracted to the point of the forceps and drawn out with ease. It would not be a bad idea to design a magnetic aural (or nasal) forceps based upon the above principles with a view to avoiding unnecessary pain and misery to the young victims.