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body, poison, muscles, disease, spasm and wound

TETANUS, a disease characterized by spasm ot some or all of the voluntary muscles. The spasms vary in rigidity, and strong ex acerbations attend their recurrence. Tetanus is a true toxannia, and occurs in several varie ties, the most familiar of which is lockjaw (trimus), whence it is commonly called by this name. The disease in all its forms (tetanus ne onatorum, puerperal tetanus, idiopathic, trau matic and rheumatic tetanus) is caused by the tetanus bacillus, which was discovered by Nicolaier in 1884. Kitasato cultivated it in 1889. The bacillus is a slender rod, round ended, existing in surface soil, dust, manure, etc., and as a rule occurring singly except in cultures. It lodges in some wound, often a slight and unnoticed wound, and the produc tion of the disease is always a proof of its presence. Except in rare instances, the bacil lus does not pass beyond the point of .infection into the body. The real nature of the tetanus poison has not yet been determined, but its virulence is deadly in the extreme, and it is rapidly absorbed by the body in which it has found lodgment. It is carried through the body in the blood.

In milder cases the spasm of tetanus may be localized in certain muscles. Various the ories regarding the action of the poison have been held by pathologists and the satisfactory explanation is still being sought by specialists in bacteriology and toxicology. Following childbirth, tetanus may infect both mother and child, and the average death rate from this disease, always high, is especially so among children. Surgical operations are sometimes fol lowed by tetanus, but antiseptic surgery has doubtless lessened its frequency, and among diseases it is regarded as rare. Within about 10 days after an injury resulting in the infec tion, it sets in, the muscles at the hack of the neck and those of mastication being usually first affected. The patient can neither masti

cate nor freely open his mouth. Often the progress to general rigidity of the muscles is very rapid, and convulsions of extreme vio lence ensue. Respiration is arrested, and death is often caused by this suspension. In other cases it results from spasm of the glottis, or from exhaustion produced by the violence of spasms.

There is no satisfactory treatment of tet anus, but such as physicians adopt is both local and general. Nothing is more important than careful cleansing of wounds, however slight, for precautionary purposes. Antitoxic disin fectants must be used, capable of destroying the poison produced by the bacilli as well as the bacilli themselves. Iodine solutions should be thoroughly applied to every tetanus wound. Potassium bromide, chloral, calabar bean, mor phine and antimony produce good results, and opium and chloroform are employed for their quieting effects. Amputation is sometimes re sorted to. Increase of fluids in the body by drinking or by intravenous injection, and cor responding increase of diuresis aid in elimi nating the poison. Antitoxin serum (see SERUM THERAPY), prepared from the blood of the immunized horse, has proved a true remedy for tetanus, and many cures have been affected by its early administration. Preventive meth ods, especially those of inoculation, are now receiving the earnest attention of specialists. Consult Wallace, 'Indian Medical Record' (1891) ; Roux, (Annales de l'Institut Pasteur' (1893) ; Bassano, (Recherches experimentales sur l'origine microbienne du Tetanos' (1900) ; Moschcowitz, ((Tetanus') in (Annals of Sur gery' (1900), Osier, W., (Annals of Medicine' (New York 1915).