The chief symptoms of Tetanus have been known since the days of Hippocrates, and apparently that ancient physician recognized an acute or unfavourable and a chronic or favourable form. E.odern writers on this disease distinguish an acute form, with short incubation period, with rapid course and generalized spasms, ending usually in death. And in the next place a chronic form, of very variable type, well described by Rose as "lentus incompletus ", of much more favourable prognosis.
Kussmaul has also described a special kind of mild - "Abortive - spasm of the muscles of neck and jaw may be the only symptoms.
These varieties appear to be only a variation in degree, and are far surpassed in interest by another form now generally known as Kopftetanus.
Kopftetanus was first described as a distinbt 4 variety of tetanus by Rose in 1870. I-le had first observed a case in 1863, but he cites a case observed by Pollock in 1847, and one by Langenbeck in 1869. Cases had, however, been observed by Von Richter (cited by Brunner) in 1791, by 5- /g Mitchell in 1813, and by Humphry in 1837 and 1858.
Thus, though Rose was the first to draw special attention. to this variety of tetanus, and to give it a name he was by no means the first to give clinical description of a case.
Since 1870 a variety of names havie been suggested, Kopftetanus or Cephalic Tetanus. Tetanus hydrophobicus (Rose) 53 Cephalic Tetanus with Facial Paralysis ( Villar) Bulbar Tetanus (Janin) NS Tetanus Paralyticus (Klemm)
The last mentioned name, for reasons yet to be mentioned, is the best. The term in general use, however, is Kopftetanus: and consultation of the literature under this heading soon shows, that it is made to cover two classes of cases. in both classes, there is history of a wound in the region of head or face, there are tetanie spasms either localised to muscles of face, jaw, and neck, or generalised and there is the frequent presence of dysphagia, or of dyspnoeic attacks. -We 1e find, in short, the symptoms of ordinary tetanus, with perhaps a tendency to localisation of the spasms in the neighbourhood of the wound, and to dysphagic and suffocative phenomena.
in one of these classes, by much the larger, we find mention made of an altogether distinguishing symptom, viz. paralysis, affecting as ä. rule, the facial nerve.
I do not think that the non -paralytic group can be so satisfactorily distinguished from ordinary tetanus as to deserve a special name, and it should not be included under the term Kopftetanus, if that name is to be applied to cases exhibitinE paralytic phenomena.
In the following discussion of the cases. collected from the literature, these two groups of cases Will be`treétëd 'separately. In February 1903, while acting as resident - physician with Dr. Andrew Smart. I had the opportunity of observing a case of Kopftetanus, which came under his care. Py Dr. Smarts kind consent, I am enabled here to give an account of this unpublished case.