736 PATHOGENIC MICROORGANISMS 



chin forward on the chest. Gradually there develops a spasm of 

 the muscles of the cheeks which results in a drawing up of the 

 tissues about the mouth, giving a curious and characteristic expres- 

 sion. Gradually the spasms extend to the trunk and back, with 

 the development of opisthotonos after several days. Difficulty in 

 swallowing may ensue, and there may be involuntary movements 

 of urine and feces. The localization of the symptoms to some 

 extent follows the location of the injury. Tetanus may occur in 

 the new born, occasionally, developing soon after birth. For differ- 

 ential diagnosis, it is best to refer to books on general medicine 

 and surgery. 



Many types of atypical tetanus in untreated and in prophy- 

 lactically treated cases have been reported, a description of which 

 can be found in extenso in the volume on "The Abnormal Forms of 

 Tetanus" by Courtois-Suffit and Giroux in the British Medical War 

 Manuals, published in 1918. They speak of splanchnic tetanus char- 

 acterized especially by the involvement of the muscles of deglutition 

 and respiration, with great dysphagia. Simple cephalic tetanus in 

 which the infection may be confined to the head, is a type in which 

 dysphagic and paralytic symptoms are never present, and which 

 result most frequently from wounds of the head. It may be char- 

 acterized only by unilateral and bilateral trismus, or by contraction 

 of muscles of the face. There is, however, a dysphagic form of 

 this in which pharyngeal spasms precede trismus. Rarely they have 

 noticed a so-called hydrophobic form in which convulsions accom- 

 pany the spasms. 



PROPHYLACTIC USE OF TETANUS ANTITOXIN 



The most important use for tetanus antitoxin which has been 

 found hitherto, is its prophylactic administration. The methods of 

 applying this have varied in different parts of the world and in 

 different armies. That it is of great value was demonstrated by 

 the almost immediate reduction of tetanus in wounded soldiers after 

 the universal introduction of prophylactic tetanus antitoxin in all 

 the armies in the field. The wounds which are particularly danger- 

 ous as far as tetanus is concerned are those in which there is con- 

 siderable laceration, especially injury to bone, and in which dirt, 

 and especially manured soil or soil from cultivated fields, and feces, 

 are likely to be present. The growth of tetanus bacilli is favored 

 by the presence of dead tissue and other infected organisms. Studies 



