12 
Laboratories, New York, N. Y. (license No. 17); New York State 
department of health, Albany, N. Y. ; and the department of health 
of the city of New York, N. Y. 
HISTORICAL REVIEW. 
Compared with the major plagues of man lockjaw has always been a 
rare disease. It is on account of the peculiar and characteristic 
spasms that it early attracted attention. In the writings of Hippoc- 
rates cases of tetanus are described, diagnosed, and prognosis given. 
From the learned Aretaeus of Kappadoza we have a description of 
tetanus that holds until modern times.® Aretaeus described an 
opisthotonos, an emphrothotonos, and a tetanus, depending upon 
whether the muscles of the back, the abdomen or the general muscular 
system were affected. To this classification pleurothotonos was 
later added when the muscles of one side were especially affected. 
Throughout the Middle Ages our knowledge of tetanus remained 
at a standstill. The symptoms of the disease so plainly indicated 
that the lesions are localized in the nervous system that, with the 
introduction of studies in pathologic anatomy, the brain, spinal cord, 
and nerves were studied to determine the seat and nature of the 
illness. It was not, however, until about the end of “the sixties” in 
the last century that experimental studies in wound infections began 
to throw light upon the chaos of theories. A review of the historical 
development of these theories is exceedingly interesting, for they 
mirror the prevailing thought upon the nature of disease, as it 
developed from that of evil spirits, through the “humoral” theory, 
the realm of miasm and noxious effluvia, to the germ theory. 
It was long known that tetanus was a complication of wounds. 
Micheles, 1797, thought it was due to irritation of the peripheral 
nerves from foul secretions in certain wounds (“wound insults”). 
Tetanus could not escape the rheumatism theory, which has been 
such an alluring catch-all for symptoms and diseases difficult of 
explanation. In cases of wound tetanus in which no plausible 
explanation seemed possible it was called rheumatic wound tetanus. 
“Taking cold” was assigned its usual role here as elsewhere. Wlien 
no assignable cause seemed at hand the disease was given the learned 
title “idiopathic tetanus.” 
About 1860 Heiberg and Rose, and Billroth and Spencer Wells ^ 
attached tetanus to the list of zymotic diseases and believed it due to 
a miasm, the spasms being caused by a poison in the blood similar to 
strychnine. 
a A part of the historical data are taken from Von Lingelsheim’s article on Tetanus in 
Kolle & Wassermann’s Handbuch der pathogenen Mikroorganisinen, vol. 2 , p. 566-600. 
^ Billroth and Spencer Wells. Wiener med. Presse, 1869, p. 36. 
