CHAPTER XVII. 



TETANUS.i 



Synonyms. — Lockjaw. German, Wundstarrkrampf. 

 French, Tetanos. 



Introductory. — Tetanus is adisease which in natural conditions 

 affects chiefly man and the horse. Clinically it is characterised 

 by the gradual onset of general spasms of the voluntary 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 fea- 

 ture 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 demonstrated the trans- 

 missibility of the disease. Nicolaier (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 inoculation, and in this pus, 

 besides other organisms, there was always present, when tetanus had occurred, 

 a bacillus having certain constant microscopic characters. Inoculation of fresh 

 animals with such pus reproduced the disease. Nicolaier's attempts at its 

 isolation by the ordinary gelatin plate-culture method were, however, un- 



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

 essential pathology probably differs from tetanus. This remark of course does not 

 exclude the possibility of the occurrence of true tetanus in very young subjects. 



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