Serious wound infection, caused by the poison (toxin) of the tetanus bacillus This disease is now rare as a result of a vaccination programme. The infection is usually the consequence of a wound which comes into contact with contaminated earth or with street refuse. The bacterium grows in the wound and releases its toxin. This is spread via the bloodstream and along the nerves, and stimulates the nerves and muscles, producing extremely painful muscular spasms. The spasms are sometimes local, but usually the whole body is affected. The symptoms develop a few days to a few weeks after the injury, and begin with spasms in the jaws and face, with lockjaw and a grimacing expression as a result. When spasms occur in the throat muscles, swallowing becomes difficult. After this the rest of the body becomes affected, and respiratory difficulties which can endanger the patient’s life may arise. When the disease reaches its height, the victim is extremely sensitive towards any stimuli, such as sounds. These can cause a sudden and total spasm. One complication is pneumonia, which may be the consequence of swallowing the wrong way. Sudden spasm can result in the fracture of a dorsal vertebra. The disease is frequently fatal if not treated. Treatment is by hospitalization, keeping the patient in a quiet room and the first step is to treat the wound. Antibodies are administered to remove as much tetanus poison as possible, and antibiotics are given to stop the growth of bacteria. The spasm is reduced by administering muscle relaxants. Painkillers and tranquillizers are often also given. When respiratory difficulties arise, artificial respiration is immediately applied. Practically all children in Britain are vaccinated with anti-tetanus vaccine. Booster vaccinations are necessary at intervals. Vaccination is also carried out again when a ‘dirty’ wound or bite is sustained.