TETANUS. 154 TETRAGRAMMATON. ized by tonic spasms of the voluntary muscles, with marked exacerbations. The contractions ni.iy be confined to the muscles of the lower jaw (trismus), to certain other groups of muscles, or involve all the muscles of the body. The disease is dependent on a bacillus, discovered by Nieolaier in 1884, and cultivated by Kitasato in 1880. The bacillus forms a slender rod with rounded ends, and exists iu dust and surface soil. Tliis accounts for the fact that wounds infected by dust are often followed by tetanus. The organism gains entrance to the tissues often through Aounds so slight as to be overlooked. The disease may follow surgical operations or childbirth, infecting the mother through the par- turient canal and the child via the cut um- bilical cord. Vaccination wounds are sometimes the port of entry for the bacillus. In a very few instances the disease is claimed to be idiopathic and to follow exposure to cold or damp. After an injury the disease sets in usually within ten days. Without any warning the pa- tient feels a stift'ness at the back of the neck, and then in the jaws, so that he is unable to open his mouth widely or to masticate properly. These symptoms continue for a day or two, or the patient may rapidly come to the stage of general rigidity, in which the muscles of the trunk and e.xtremities are afl'ected. The back becomes rigid and arched (opisthotonus) ; the mtiscles of the abdomen become hard and board- like; respiratory movements are limited by the rigid muscles. By this time the jaw is iirnily closed by contraction of the masseter muscles, and the other muscles of the face drawn into the jiainful smile known as the risiis snrdoiiiciis. AVhen this stage has been reached violent con- vulsions of the hitherto rigid muscles supervene. During a paroxysm the patient's teeth are tight- ly clenched, while the breathing process is held in temporary suspension, with imminent danger of death. The spasms are intensely painful, and occur at first at intervals of half an hotir or more with gradually increasing freqvieucy as the disease progresses. Muscular contractions are sometimes so forcible as to rupture a muscle or break a bone. In a majority of eases the dis- ease progresses to a fatal end in a few days ; the paroxysms become more violent and fre- quent and death comes from exhaustion, fi.xa- tion of the respiratory muscles, or spasm of the glottis. There may be little fever during the attack, but before death an extraordinary rise in temperature may take place. The treatment of tetanus is unsatisfactory. About 90 per cent, of the tramuatic cases die, and about .50 per cent, of other cases, the result depending to a great extent on the size of the wound and severity of the infection. The bacilli multiply and prodvice their toxins in the neigh- borliood of the injury, and w'hen this can be found it is to be opened freely and treated with antiseptics to prevent further infection. The drugs having the best results in tetantis are chloral, potassium bromide, and calabar bean, with the occasional use of chloroform to control violent spasms and opium to produce sleep. In many cases cure follows the injection of an anti- tetanic sermu, derived from the blood of a Jiorse that has been rendered immune by repeated in- jections of a culture of the bacillus, (See Se- bum TiiEK.ii'y.) A great many eases of infantile tetanus can be prevented by antiseptic treatment of the stump of the umbilical cord. Tetanus in infants (trismus nascentium) is very fatal, being uninfluenced even by antitoxin. Consult: Moschcowitz, Tetanus (Philadelphia, 1000) ; Bassano, Rccherclies cxperimcntalrs siir I'ori- giiie microhicnnc du tctanos (Paris, 1900). TETANUS, IX Animals. A disease attributed to the action of Bacillus tetani. which attacks domestic animals, most frequently horses and sheep. It is usually produced by cold and wet, by intestinal worms, olistinate constipation, or in- juries. Considerable doubt exists, however, as to the nature of spontaneous tetanus. The snup- toms usually come on gradually, involving most of the muscular structures, which become hard and rigid. The nose is protruded, the limbs move stilfly, the tail is tipraised. the bowels are con- stipated. The patient must be kept perfectly quiet, and in an airy but comfortably warm place, and plentifully supplied with cold water, and soft, sloppy, but nutritious food, which he will usually greedily suck in through his liruily closed teeth. Any discoverable woiuid should be fomented or poulticed ; bleeding, sedatives, and all causes of irritation must be avoided. The only promising treatment thus far discovered consists in injec- tions of antitetanus sertun as soon as the disease is diagnosed. Jlany cases of tetantts may be pre- vented by applying antiseptic washes to wounds in which the tetanus bacillus may become lodged. In adult animals most cases are fatal: but among young animals, especially when the attack results from exposure to cold, many recoveries occur. TETE DE PONT, tat dc pox (Fr.. bridge- head). An important field-work fortification, generally open at the gorge. The flanks rest on the banks of a river, thus sectiring connnani of or covering one or more bridges. See Foeti- ric.4Tiox. TE'THYS (Lat., from Gk. TitHlr), In Greek mythology, daughter of Uranus and Giea. and. by Oceanus, mother of the Oceaiiids and river gods. TETRACHORD (from Gk. TSTpaxopSo^, tctnichordos. having four strings, from rfrpa-, ietra-, four -+- xop^'l^ chord?, string, cord). In music, a system of four tones comprised within the compass of perfect fourth. The Greek scales were composed by joining two tetrachords. In the Middle Ages the tetrachord was superseded by the hexachord, introduced by Guido d'Arezzo. See Greek ^Ifstc. TETRADYMITE (from Gk. vrrpaSviio^. tet- rudymos, four-fold, from ri-pn-, tctra-, four; so called from its frequent occurrence in twin crystals). A mineral bismuth telluride frequent- ly containing sulphur and selenituu. It is crys- tallized in the hexagonal system, has a metallic lustre, and is of a steel-gray color. It is fotind in Norway, Sweden, and in the United States at various localities in Virginia and North Carolina. TET'RAGR AMTVEATON ( Gk. Terpaypaufta- Tov, word of four letters, neu. sg. of -trptiypapiin- rof, fctrafiniminatos, having four letters, from re-rpa-, tetra-, four -+- ypa/ifia, grniiima. letter, from ypd<pen f/raphein. to write) . A term used to designate the name of Israel's God. consisting of the four letters Y H W H. In the Massoretic text it occurs (5823 times and is written with the vowels of .^donai 'Lord' (originally 'my Lord'), or with those of Elohini, 'God.' By these vowels
