Tetanus is not a commonly encountered disease; consequently, individual physicians acquire little experience with this grave medical emergency which requires prompt and expertly administered treatment. Since medical literature on the pathogenesis and treatment of tetanus is vast and confusing, the object of this report is to present a rational approach to the treatment of tetanus derived from personally observed cases, a review of the literature, and an analysis of 70 cases treated by various methods at Gorgas Hospital from 1905 to 1956.
The tetanus bacillus (Clostridium tetani) is a saprophytic organism having no invasive property and therefore tends to remain at the inoculation site. The bacillus causes disease by elaboration of a powerful watersoluble exotoxin during its proliferative phase; this toxin then leaves the focus of production to reach all tissues of the body and has the capacity of acting upon the central nervous tissue of susceptible animals to produce