TETANUS. 385 



tissues are which induce tetanus, nor how they affect the, spinal marrow. 

 The injection and swelling in the course of the nerve, between the 

 wound anithe spinal marrow, which have sometimes been observed, are 

 by no means constant. In other cases, lockjaw occurs from the effect 

 of cold, without any previous wound, as when a man has slept upon 

 the moist earth, or been wet while his body is heated. This form of 

 rheumatic tetanus is much more rare than the traumatic form. Here, 

 too, we are completely in the dark as to the ways and means by which 

 the lesion, suffered by the cutaneous nerves in rheumatic tetanus, is 

 transmitted to the spinal marrow. The tetanus observed sometimes 

 in newly-born infants (tetanus neonatorum) is usually regarded as a 

 third form of the disease, although it should properly be reckoned as 

 belonging to the traumatic variety. Tetanus neonatorum never occurs 

 excepting between the first and the fifth day after the fall of the navel- 

 string. Hence it has always been immediately preceded by a wound 

 (ligation and binding of the cord). The objection that, in some cases, 

 there is inflammation of the umbilicus, while in others there is none, 

 is not valid ; for, even in the wounds of adults which have caused lock- 

 jaw, although, in most cases, they are violently inflamed, and other- 

 wise affected, yet there have been instances in which the wound was 

 doing perfectly well, and was healing, or even was completely cica- 

 trized. Besides, in infantile tetanus, the ligation and division of the 

 umbilical cord can only be considered as the remote cause, while the 

 chilling of the skin, or other unknown agent, which sometimes seems 

 to be of an epidemic nature, must be regarded as the immediate cause. 

 Finally, a morbid condition of the spinal cord is induced by poisoning 

 with strychnine, which exhibits precisely the same symptoms as those 

 of lockjaw, so that the toxic signs induced by strychnine and brucine 

 have been called tetanus toxicus. 



Traumatic and rheumatic tetanus is of far more frequent occurrence 

 m men than in women. Vigorous constitutions are more liable to it 

 than feeble ones. In the tropics the disease is more common than 

 with us ; and certain races, especially negroes, seem to be more prone 

 to the disease than Europeans. 



SYMPTOMS AND COURSE. Tetanus is characterized by continuous 

 tonic spasms, which principally Evolve the muscles of the trunk and 

 those of mastication, and which are marked by paroxysmal period? 

 of aggravation of extreme intensity. 



The malady is usually preceded by signs consisting of a febrile 

 condition of no great severity, and pain, and stiffness in the back of 

 the neck, which may readily be mistaken for a trifling fit of rheuma- 

 tism. If such symptoms make their appearance after receipt of a 

 wound of the character above given, and if at the same time the 



