Group IV. 



INFECTIOUS DISEASES WITH SPECIAL INVOLVEMENT 

 OF THE NERVOUS SYSTEM. 



1. Tetanus. Lockjaw. 



[Ti'tanos [French]; Sfarrkrampf [German]; Tetano [Italian].) 



Tetanus is an acute infectious disease resulting from an in- 

 toxication of the nervous system, characterized by per si sting- 

 spasmodic contractions of the entire body musculature or of 

 single groups of muscles, without impairment of consciousness. 

 The disease is caused by Nicolaier's bacillus tetani and its 

 poisonous products of metabolism. 



History. The opinions concerning the nature of this disease were 

 until quite recently based on purely theoretical grounds. The associa- 

 tion between muscle spasm and the increased irritability of the nervous 

 system was recognized during the 18th century, but the real cause 

 of the nervous affection remained a mystery. The most generally prevail- 

 ing view was that tetanus, which was so often associated with injuries, 

 arose reflexly as the result of severe traction or contusion of peripheral 

 nerves and that the irritation thus originated was transmitted to the 

 spinal cord (tetanus traumaticus), but the efforts to produce the disease 

 experimentally in this manner all failed (Arloing & Trippier [1869]). 

 Since in other cases no preceding traumatism could be demonstrated 

 (T. idiopathicus) the cause was sought in other circumstances, par- 

 ticularly in colds (T. rheumaticus) and even in psychic excitement 

 (T. psychicus), although several authors (Travers, Rose, Spencer Wells) 

 were already inclined to consider the disease an intoxication. 



Etiological research was directed into a more correct channel when 

 Carle & Rattone (1884) succeeded in producing the disease artificially 

 by inoculating the contents of an acne pustule of a person who had 

 died from tetanus into rabbits. Almost at the same time Nicolaier 

 (1884) obtained positive results by inoculation of garden earth into 

 rabbits, guinea pigs, and mice, and at the same time recognized the 

 cause of the disease in the form, of a spore-bearing bacillus. Later 

 observations (Rosenbach, Baeumer, Bonome) have confirmed the in- 

 fectious nature of the disease for man, while Nocard (1887) established 

 the identical origin of tetanus of horses. 



Kitasato (1889) was the first to grow the anaerobic bacillus in 

 pure culture; Brieger (1887) demonstrated the presence of toxic sub- 



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