Synonyms: Trismus, Lockjaw.
Tetanus is an acute infectious disease, of relatively infrequent occurrence, invariably of microbic origin, characterized by more or less tonic muscle spasm with clonic exacerbations, which, for the most part, occurs first in the muscles of the jaw and neck, involving progressively, in fatal cases, nearly the entire musculature of the body. Certain races of people seem predisposed, and in certain climates and geographical areas the disease is exceedingly prevalent. Negroes, Hindoos, and many of the South Sea Islanders show a peculiar racial predisposition, and, in a general way, inhabitants of warm countries are less resistant. This is shown partly by the fact that in various European wars the Italians and French have suffered more than the soldiers of more northern climes. Tetanus is by no means confined to adult life, since infants are far from exempt, and in the tropics the trismus of the newborn is the cause of a high mortality rate. In Jamaica one-fourth of the newborn negroes succumb within eight days after birth, and in various other hot countries the proportion is at times equally great. One plantation owner states that fully three-fourths of the colored children born upon his plantation succumbed to the disease. The peculiar reason for this infection will appear later when speaking of tetanus neonatorum. Men seem more commonly affected than women, probably because of their occupations, by which they are more exposed. Military surgeons have had to contend with the disease in its most virulent form, and it has been noted that soldiers when worn out by fatigue or suffering from the disaster of defeat seemed more liable to the disease. In 1813 the English soldiers in Spain suffered from tetanus in the proportion of 1 case to 80 wounded men. In the East Indies, in 1782, this proportion was doubled. Quick variations of heat and cold, such as warm days and cold nights, coupled with the other exposures incidental to military life, seem to exert a great effect. Curiously enough, the wounded in many campaigns who have been cared for in churches have suffered more from the disease than those cared for in any other way. Tetanus, however, is by no means necessarily confined to any one clime or race, but may be met with anywhere, at any time, providing only that infection has occurred. A celebrated Belgian surgeon lost by tetanus ten cases of major operations before he discovered that the source of the infection was his hemostatic forceps. As soon as these were thoroughly sterilized by heat he had no further undesirable complications. If the disease can be conveyed by the instruments of a careful surgeon, how much more so by the dirty scissors of a careless midwife, etc.
It is true, also, that the popular notions of the laity concerning the liability to tetanus after certain forms of injury are not ill-founded. Small, ragged wounds of the hands and feet are those which ordinarily receive little or no attention, and are among those most likely to be followed by this disease. The toy pistol, which, a few years ago, was such a prevalent and widely sold children’s toy, was the cause of many a small laceration of the hand, due to careless handling and the peculiar injury produced by the explosion of a small charge of fulminating powder in a paper or other cap. It was not the character of the laceration or injury thereby produced, but the fact that such injuries occurred in the dirty hands of dirty children, which were most likely to become infected, that has caused the so-called toy-pistol tetanus to be raised almost to the dignity of a special form of this disease. During the month of July, 1881, in Chicago alone, there were over 60 deaths from tetanus among children who had been injured in this way by these little toys. This led to their sale being suppressed by law.
Etiology.
—Two theories have had strong advocates, one being that which would account for the disease by irritation of nerves; while the second, the humoral, would explain the disease by alterations in the blood. Each has had its most ardent defenders, but both have now completely yielded to the investigations of a few observers, among whom Kitasato and Nicolaier are the most prominent. These ardent workers were, in 1885, able to clearly establish the parasitic nature of this disease, and to isolate and investigate the organisms by which it is produced.
Fig. 17
Tetanus bacilli, showing spore formation. (Kitasato.)
The bacillus of tetanus is a somewhat slender, rod-shaped organism, with a peculiar tendency to spore formation at one end, which gives it a drumstick appearance. It is essentially an anaërobic organism, and can never be cultivated in contact with the air. In laboratory experiments it is grown in the depths of a solid culture medium or else in fluids and on surfaces in an atmosphere of hydrogen gas. It is one of the apparent contradictions of bacteriology that this organism, which can only be grown as an anaërobe, nevertheless abounds in earth, particularly the rich, black loam which best supports luxuriant vegetable life, and that it practically inhabits the upper layers of the soil, which accounts for the fact that so many contaminations and infections have occurred from stepping upon planks or boards with nails projecting, or from introduction of splinters, or from lacerations of the hands and feet which are so often followed by contact with such materials. There is nothing about a rusty nail wound which, by itself, predisposes to tetanus, but the rusty nail upon which a person steps is either itself infected or leaves a rent or wound which may become infected within the next few moments, and which is not likely to receive the careful attention which it should. Verneuil has of late laid stress upon the fact that in localities where horses are kept tetanus is more prevalent, and that the infectious organism abounds in and upon stable floors, about barn-yards, and wherever the excretions of a horse may be found. Bacteriologists are aware that in the intestines of herbivorous animals the bacilli (anaërobic) of tetanus and malignant edema are often found. Verneuil has further shown that almost the only instances of tetanus which occur on shipboard are upon those ships which are used for transportation of horses and cattle. His statements are at least interesting, if not absolutely well-founded. At all events, tetanus is certainly of telluric origin.
A French veterinary surgeon of twenty-five years’ experience had not seen a single case of tetanus until 1884, when he “removed a tumefied testicle from a horse, with the ecraseur, and it died of tetanus; in the following six months he castrated five, and all died; another castrated fifteen in one day, and all died but one; another in ten days castrated six bulls and operated on three fillies for umbilical hernia, when five of the bulls and one of the fillies died.” This will illustrate how the infectious agent may be conveyed by instruments, etc.