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Tetanus Neonatorum: What the Ancient Chinese Knew ♦ 1442

Tetanus Neonatorum or neonatal tetanus is also known in Western medicine by the terms trismus nascentium, 7-day sickness, 9-day fits and the lock-jaw of infants. In ancient Chinese medicine it was called infant cord body stiffness. Acute involuntary tetanic contractions of striated muscles result from the irreversible binding of the exotoxin, tetanospasmin, to synaptic membranes of motor neurons. The exotoxin is the product of the spore-forming gram-positive anaerobic bacillus, Clostridium tetani. Prior to the 20th C., mortality in newborns in the West approached 100%, with 5 to 90% of all newborns infected. Entry of the organism in the adult is almost always through a traumatic injury. In the newborn, the organism is almost always introduced at the time of division of the umbilical cord by an unsterile knife or scissor. Asceptic techniques will almost always prevent the disease from developing, even in unimmunized populations.

The etiology and mechanism tetanus neonatorum was the subject of debate and uncertainty throughout more than 2,000 years of recorded Western medicine. Even as late as 1884, Western physicians considered foul air and occipital compression the leading pathogenetic mechanisms. The concept of prevention of the disease by proper handling of the cord was not even suggested. In contrast, by the third century BC (Qin Dynasty), Chinese physicians had definitively linked adult and newborn forms of the disease, had identified the umbilical cord as the site of entry of a foreign (cold) substance, and had even recognized the danger of exposing the newborn infant to the soil. During the next 2,000 years, Chinese physicians advanced their knowledge and by the end of the Ming Dynasty (1644) recognized the importance of prevention of the disease by utilizing flamed instruments for cutting the umbilical cord. They also proposed avoiding instrumenal cutting of the cord entirely by tying the cord tightly with silk, wrapping it in clean linen and having the mother chew through the cord with her teeth. Cauterization (moxabustion) of the umbilical stump immediately after division was also advocated.

The delay in recognition of the mechanism of tetanus neonatorum by Western physicians will be contrasted with early Chinese understanding of the pathogenesis and prevention of the disease.

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(Mr. Charles Stone, of the Department of East Asian Languages and Civilizations at The University of Chicago, translated the ancient Chinese medical texts into English.)

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Gartner, L. Tetanus Neonatorum: What the Ancient Chinese Knew ♦ 1442. Pediatr Res 43, 246 (1998).

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