TETANUS.
BY P. S. CONNER, M.D.
Tetanus (τεινω, to stretch) is a morbid condition characterized by tonic contraction of the voluntary muscles, local or general, with clonic exacerbations, occurring usually in connection with a wound. Cases of it may be classified according to cause (traumatic or idiopathic); to age (of the new-born and of those older); to severity (grave and mild); or to course (acute and chronic), this latter classification being the one of greatest value.
Though known from the earliest times, it is in the civil practice of temperate regions of comparatively rare occurrence, and even in military surgery has in recent periods only exceptionally attacked any considerable proportion of the wounded.
Occurring in individuals of all ages, the great majority of the subjects of it are children and young adults. Women seem to be decidedly less liable to it than men. That this is due to sexual peculiarity may well be doubted, since the traumatic cases are by far the most numerous, and females are much less often wounded than males. The traumatisms of childbed are occasionally followed by it (puerperal tetanus).
That race has a predisposing influence would appear to be well established; the darker the color, the greater the proportion of tetanics. Negroes are especially likely to be attacked with either the traumatic or idiopathic form.
Atmospheric and climatic conditions, beyond question, act powerfully in, if not producing at least favoring, the development of tetanus. Places and seasons in which there is great difference between the midday and the midnight temperature, the winds are strong, and the air is moist, are those in which the disease is most prevalent; and it is because of these conditions that the late spring and early autumn are the periods of the year when cases are most often seen.1
1 In his account of the Austrian campaign of 1809, Larrey wrote: “The wounded who were most exposed to the cold, damp air of the chilly spring nights, after having been subjected to the quite considerable heat of the day, were almost all attacked with tetanus, which prevailed only at the time when the Reaumur thermometer varied almost constantly between the day and the night by the half of its rise and fall; so that we would have it in the day at 19°, 20°, 21°, and 23° above zero (75°–84° F.), while the mercury would fall to 13°, 12°, 10°, 9°, and 8° during the night (50°–61° F.). I had noticed the same thing in Egypt.”