TETANUS 141 



it may be, as much as a fortnight, when the primary wound may be 

 almost forgotten, general symptoms occur. Their appearance is often 

 the first sign of the disease. Stiffness of the neck and facial muscles, 

 including the muscles of the jaw, is the most prominent sign. This 

 is rapidly followed by spasms and local convulsions, which, when 

 affecting the respiratory or alimentary tract, may cause a fatal result. 

 Fever and increased rate of pulse and respiration are further signs 

 of the disease becoming general. After death, which results in the 

 majority of cases, there is very little to show the cause of fatality. 

 The wound is observable, and patches of congestion may be found 

 on different parts of the nervous system, particularly the medulla 

 (grey matter), pons, and even cerebellum. Evidence has recently 

 been forthcoming at the Pasteur Institute to support the theory 

 that tetanus is a "nervous" disease, more or less allied to rabies, 

 and is best treated by intra-cerebral injection of" antitoxin, which 

 then has an opportunity of opposing the toxins at their 'favourite 

 site. The toxins diffuse throughout the tissues of the body, but 

 particularly affect the spinal cord. The long incubation period 

 indicates that the toxins are probably produced by a ferment of 

 some kind. Whatever its exact nature, it is undoubtedly a most 

 powerful poison. 



Tetanus bacilli spores have been found in considerable quantities 

 in the dust of dry jute fibre (Andrewes), and various cases are on 

 record where the disease has been contracted by workers in jute 

 mills in Dundee and elsewhere. Legge attributes the presence of 

 the bacilli in the jute (Corchorus) to the soil in which it is grown in 

 Bengal. 



The Bacillus of Tetanus. — In the wound the bacillus is present 

 in large numbers, but mixed up with a great variety of suppurative 

 bacteria and extraneous organisms. It is in the form of a straight 

 short rod with rounded ends, occurring singly or in pairs or threads, 

 and slightly motile. It has been pointed out that by special methods 

 of staining flagella may be demonstrated. These are both lateral 

 and terminal, thin and thick, and are shed previously to sporulation, 

 Branching also has been described. Indeed, it would appear that, 

 like the bacillus of tubercle, this organism has various polymorphic 

 forms. 'Next to the ordinary bacillus, filamentous forms predominate, 

 particularly so in old cultures. Clubbed forms, not unlike the 

 bacillus of diphtheria, may often be obtained from agar cultures. 

 Without doubt the most peculiar characteristic of this bacillus is its 

 sporulation. The well-formed round spores occur readily at incuba- 

 tion temperature. They occupy a position at one or other pole of 

 the bacillus, and have a diameter considerably greater than the 

 organism itself. Thus the well-known " drumstick " form is produced. 

 In practice the spores frequently occur free in the medium and in 



