Section II. TETANUS
Tetanus is a disease caused by the toxin of an anaerobic bacillus, Clostridium tetani,
and characterized by local to generalized painful muscular contractions, plus
The bacillus produces a resistant spore, which may frequently be found in the feces of
horses and less frequently in the feces of man and other domestic animals.
The spores are found in soil throughout the world, and they produce infection
by direct or indirect inoculation of a wound.
The disease may follow any wound, burn, surgery, or trauma to an old wound
containing dormant spores.
In 10 to 20 percent of cases, there is no prior history of wounding or trauma.
The toxin acts in the spinal cord. The incubation period is 4 days to 3 weeks. The
earliest and most frequent sign is stiffness of the jaw, followed by spasm of the muscles
of the neck and jaw (lockjaw). Severity varies with the length of the incubation period.
Mortality is due to respiratory failure from spasm of the respiratory musculature. The
mortality varies from 30 to 70 percent in the U.S.
Treatment consists of adequate debridement of the wound, tetanus antitoxin in massive
doses, penicillin, sedation, prevention of respiratory spasm, and respiratory support.
Preventive measures include adequate cleansing of wounds, immunization with tetanus
toxoid or antitoxin, and surgical asepsis. Tetanus toxoid is very effective in the
prevention of tetanus. Only four cases of tetanus occurred during World War II among
wounded American soldiers who had been fully immunized and received an emergency
booster at the time of injury.