CIIAPTEK XV. 



TETANUS. 



HISTORY. The infectious nature of tetanus was well known 

 and established before the discovery of the bacillus tetani. In 

 1859 Betoli related the case of a bull that died of tetanus after 

 castration. Several slaves ate some of the flesh of the dead animal 

 and of these, three were in a few days seized with tetanus, two of 

 them dying. He adds further that in Brazil, where this occurred, 

 the flesh of animals dead of tetanus is generally regarded as capa- 

 ble of transmitting the disease. In 1870 Anger reported a case in 

 which a horse had spontaneous tetanus, after which three puppies 

 which had been in the same stable were also affected. Kelly in 

 1873 had three cases in the same week, all arising in a civil hospi- 

 tal, and a few days later there was a fourth case in a neighboring 

 hospital. 



Larger in 1853 saw a woman who had a fall while cleaning a 

 farm-yard, causing a slight wound of the elbow. Four weeks 

 later, she was seized with tetanus, and on investigation it was found 

 that a horse affected with that disease had been in a stable opening 

 into the yard where she fell. He also mentions that in a small 

 village where tetanus was previously unknown, five cases appeared 

 in eighteen months under quite different climatic conditions. Of 

 these, one had been taken to a hospital, after which two others in 

 the same ward became affected. 



Verhoogen and Baert have recently published an article upon 

 the nature and etiology of tetanus, in which these authors cite the 

 well-known endemic character of the disease in our Southern States, 

 Cuba, Ceylon, a number of the Pacific Islands, and other localities, 

 and quote a large number of circumstances that suggest the occa- 

 sional epidemic type of the affection as met in man and some of 

 the lower animals. Among a number of clinical and experimental 

 occurrences suggesting the probability of the transmissibility of 

 the malady, and the likelihood of the agent of transmission exist- 

 ing in unclean instruments, Thiriar's experience is narrated. This 

 operator was unfortunate enough to lose ten cases of major opera- 

 tions by tetanus before he determined the seat of the infection to 

 exist in his haemostatic forceps, the thorough sterilization of which 



