CHAPTER XVI. 



TETANUS. 1 



SYNONYMS. LOCKJAW. GERMAN, WUNDSTAKRKKAMPF. 



FRENCH, TETANOS. 



Introductory. Tetanus is a disease which in natural conditions 

 affects chiefly man and the horse. Clinically it is characterised 

 by the gradual onset of general stiffness and spasms of the volun- 

 tary muscles, commencing in those of the jaw and the back of the 

 neck, and extending to all the muscles of the body. These spasms 

 are of a tonic nature, and, as the disease advances, succeed each 

 other with only a slight intermission of time. There are often, 

 towards the end of a case, fever and rise of respiration and pulse 

 rate. The disease is usually associated with a wound received from 

 four to fourteen days previously, and which has been defiled by 

 earth or dung. Such a wound may be very small. The disease 

 is, in the majority of cases, fatal. Post mortem there is little to 

 be observed on naked -eye examination. The most marked 

 feature is the occurrence of patches of congestion in the spinal 

 cord, and especially the medulla. 



Historical. The general association of the development of tetanus with 

 the presence of wounds, though these might be very small, suggested that 

 some infection took place through the latter, but for long nothing was 

 known as to the nature of this infection. Carle and Rattone in 1884 

 announced that they had produced the disease in a number of animals by 

 inoculation with material from a wound in tetanus. They thus demon- 

 strated the transmissibility of the disease. Nocolaier (1885) infected mice 

 and rabbits with garden earth, and found that many of them developed 

 tetanus. Suppuration occurred in the neighbourhood of the point of 



1 This disease is not to be confused with the " tetany " of infants, which in 

 its essential pathology probably differs from tetanus (vide Frankl-Hochwart, 

 "Die Tetanic der Erwachsenen, " Vienna, 1907). This remark of course does 

 not exclude the possibility of the occurrence of true tetanus in very young 

 subjects. 



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