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Chapter 33

Tetanus

Tetanus is one of the commonest causes of death in the tropics. It has been estimated that as many as 600,000 people die from this infection per annum, and in some parts of the tropics it accounts for 70% of all neonatal deaths. In 1940, Dietrich wrote: "A complete resume of the literature on tetanus would be monumental, confusing, definitely contradictory and of little aid to the physician attempting to treat a single child with tetanus." This is still true today, and we would add that it applies equally to many other diseases!

Hippocrates knew and described tetanus and realized that, if the patient survived for 4 days, recovery was likely. Since his time, the disease has been described in a bewildering series of terms denoting the contortions of the unchecked disease, and it has been countered by "cures" which were more imaginative than helpful. Bleeding by leeches or venesection might be expected, together with hot or cold baths, blisters and clysters (enemas), but amputation, hydrocyanic acid, aconite and ipecacuanha are a little surprising! Perhaps even more astonishing was the suggestion in 1811 that the use of curare, with artificial respiration using bellows, would be beneficial in tetanus. This approach was indeed used on animals in 1835 and on human patients in 1858, but not with any resounding success because of the crude preparation of the drug and the total lack of knowledge of respiratory physiology.

Progress in the treatment of the disease was hampered by total ignorance of its cause and nature. For some time, around 1850, the weather was held to be important and patients' records of that era include full information about the local weather conditions. It is just as well that we are not dependent on accurate weather forecasting today for the prevention of tetanus . . .

Synonyms

Lockjaw. Sp: Tetanos. Fr: Tetanos. Ger: Tetanus. Wundstarrkrampf. Starrkrampf.

Definition

Tetanus is an infection with Clostridium tetani.

Geographic Distribution

Tetanus occurs worldwide and at all seasons. It is more common in warm, tropical countries and in rural areas, where the soil is fertile and highly cultivated, and where the standard of living is low. It is most likely to occur where shoes are not worn and where the legs are unprotected by clothing. It is most frequent in farmers, housewives, and schoolchildren. However, there is a considerable geographic variation: for example, in Lesotho tetanus is rare, but in Nigeria it is a very common neurological disease and at one time caused 7% of all deaths at the University Hospital in Ibadan. There is a variation in the strains of the organism and therefore in toxicity, accounting for the geographic difference in morbidity and mortality.

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Copyright: Palmer and Reeder