For Lockjaw Crisis: High-Pressure Oxygen

By the time he got to St. James Hospital in Chicago Heights, 25 miles south of the Loop, Farmer Ralph Douma, 72, was already in desperate shape. His jaw was stiff, and he could hardly open his mouth. He had difficulty in swallowing, and he was suffering from severe pains in his legs and back. St. James doctors had no trouble diagnosing Douma's problem: he was dying from tetanus (lockjaw) caused by a dirty wooden splinter he had picked up in his chicken yard 13 days before.

Without much hope, the doctors started all the standard treatments: a hefty shot of tetanus antitoxin (to counteract the poison released by the bacteria in the festering wound), penicillin to reduce the spread of infection, sedatives to calm the anguished patient, and muscle relaxants to ease his stiffening, contorted body. They cleaned the infected wound and put Douma in an oxygen tent (because the nerve center that controls breathing is especially susceptible to tetanus poison). But it seemed to be too late. During the next 24 hours, Douma suffered several convulsions and muscle spasms. His back arched like a bow.

Gas Gangrene & Oxygen. Still the four doctors on the case tried to think of something else to do for the stricken farmer. One of them remembered having read last year in the professional journal Surgery about patients infected with gas-gangrene bacilli; oxygen treatment in a compression chamber had apparently helped to bring about surprising cures.

Gangrene is not the same as tetanus, but the bacilli that cause both problems are closely related; they--and possibly also the poisons they make--are destroyed by an excess of oxygen. The Surgery report was by Dr. I. Boerema and his colleagues at Amsterdam's Wilhelmina Hospital, but a hasty transatlantic call failed to reach Dr. Boerema. Eventually an assistant gave the necessary information, and with the consent of Douma's family, the Chicago Heights team decided to go ahead.

There was much to gain, and with every passing minute there was less to lose.

First problem was to find a compression chamber (usually used for slow decompression of divers and tunnel workers to guard against "the bends"). A construction company in McCook, 30 miles away, agreed to send in one of the 6-ft. by 16-ft., four-ton monsters by trailer truck. It was 1 a.m., 38 hours after his admission, when Douma was carried into the chamber after it was finally set up in a lot at the rear of the hospital. Two doctors fitted him with a special oxygen mask, and stayed with him inside the steel chamber as he was flooded with about 50% oxygen.

They sent the pressure up to three atmospheres (44 Ibs. per square inch), held it there for two hours, then slowly dropped it back to normal.

Then Douma was taken back to his hospital bed and conventional oxygen tent. It was too soon to be sure of any improvement, but at least he was no worse. Twelve hours later, the doctors gave him a second high-pressure treatment. After that, as his muscles relaxed and his arched back straightened, Douma was clearly on the mend. Just five days after entering the hospital, and little more than three days after his first tank treatment, Douma spoke for the first time. His lockjaw had eased enough for him to swallow water and milk, and he seemed well on the way to recovery.

Death for Half. Exactly why the compression chamber treatment worked so well, Farmer Douma's doctors are not sure. They know that the penicillin they administered kills tetanus bacilli; oxygen presumably helps to kill them faster. Oxygen's effect on poisons manufactured by the bacilli is not yet known, so the Douma case alone proves little. But one of the doctors remarked: "It's amazing that such a relatively simple and obvious treatment, based on an old but neglected principle, should have to wait until 1962 to be tested." Equally amazing is the fact that although lockjaw is almost entirely preventable by vaccination, only one American in four bothers to get the preventive tetanus toxoid shots. Half the 450 tetanus cases reported in the U.S. each year still die unnecessarily.

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