TETANUS. 239 



small animals immediately, after the development of tetanic 

 manifestations. Tetanus-toxin has been found on several 

 occasions in the urine of tetanus-patients, but never in the 

 sweat or in the saliva. 



The portal of infection is ascertainable in the majority 

 of cases. Often it is a wound of considerable extent, which 

 can not escape observation as in puerperal tetanus the 

 wounded surface of the uterus, in tetanus of the new-born 

 usually the umbilical wound, in cephalic tetanus (hydro- 

 phobic tetanus) an injury of the head. The source of infec- 

 tion, also, may often be discovered without difficulty. Not 

 rarely a relation between the patient and horses can be 

 elicited, as these animals, according to Verneuil, occupy a 

 central position in the etiology of tetanus and they may 

 convey the tetanus-bacillus to the ground with their manure ; 

 or the patient may have introduced beneath the skin a 

 splinter to which the bacilli were adherent ; or in working 

 about a garden he may have contaminated an already 

 existing wound with earth ; and the like. 



It should here be mentioned that tetanus-virus retains 

 its virulence for an exceedingly long time. An observation 

 has been recorded in which a splinter of wood that had 

 already given rise to infection again caused tetanus after 

 the lapse of eleven years. Bandages and dressings from 

 tetanus-wounds likewise preserve their infectivity for a long 

 period, and tetanus-cadavers also retain for a considerable 

 time their capability of causing tetanus. 



Direct contagion has also been observed, tetanus having 

 been transmitted in a hospital-ward from one patient to 

 his neighbor, or several patients occupying successively the 

 same bed each developing tetanus. In some cases, 

 however, the portal and the mode of infection are 

 ascertainable with difficulty. Cases have been reported in 

 which operation-wounds, after antiseptic treatment, healed 

 by primary union and without complication, and later 

 tetanus developed (cicatrix-tctanus). Further, there occur 

 cases of so-called idiopatliic or rheumatic tetanus in which 

 apparently no lesion exists anywhere, and also at autopsy 

 no suppuration can be found. The information gained from 

 experiments on animals furnishes a complete explanation for 

 these cases. The portal of entrance may be the smallest 

 abrasion or fissure of the skin, which will escape observation, 

 and which perhaps has already healed some time before the 



