Tetanus is an acute infection produced by a bacillus which enters the body through an abraded surface, develops toxins in the system, and causes greatly exaggerated irritability of the central nervous system. With the heightened reflexes, tetanic contraction of the voluntary muscles occurs, especially of those of the jaw, face, and the extensors of the back. The ordinary reflex action from peripheral excitation is so far intensified that the slightest pressure on the surface of the body, or change in surrounding temperature, or even a loud sound, may throw the patient into violent convulsions and painful tonic spasms. Efforts in swallowing may induce them. The muscles of the jaw are often set in a condition of rigid contraction, making it impossible for the patient to open the mouth to take food, and forcible efforts to separate the teeth excite convulsions. It is necessary to support the strength by every available means, for tetanus is not invariably a fatal disease, although, according to Gowers, death results in about 90 per cent of all cases.

Dietetic Treatment

Food can only be given in liquid form, but if a front or side tooth is absent a soft-rubber catheter may be passed in between the set teeth and fluid can be conveniently poured into the mouth through it. Milk, egg albumin, eggnog, nutritious beef, mutton, or chicken broths, malted gruels, wine, brandy, and whisky should be given as frequently as the condition of the patient will admit. If possible, from two to four ounces should be administered every hour. The spasm does not affect the involuntary muscles, so that food is swallowed if it can be placed far back in the pharynx. Alcoholic stimulation and nourishment can also be given by the rectum, but this method is as apt to excite convulsions as mouth feeding. If severe convulsions are induced by every attempt to feed the patient, it becomes necessary to put him under primary anaesthesia by the inhalation of chloroform, and then a tube may be passed into the stomach, through which twelve or sixteen ounces of soup or predigested milk, eggnog, and stimulants may be poured. By this means he is disturbed much less often and larger quantities of nourishment are taken at one time.

In a recent case of tetanus which came under my observation, and in which tetanus bacilli were found, the muscular spasms were intense and almost continuous for over five weeks. The difficulty in feeding the patient was extreme, and emaciation was very pronounced. He complained incessantly of thirst, and often of hunger, but he was able to swallow milk broths and stimulants given between the closed teeth in very frequent doses, and his final recovery was attributable mainly to persistent efforts at careful feeding, chloroform anaesthesia having been several times successfully employed to relax spasm.