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Established tetanus is an emergency: minimize provoked muscle spasms, protect breathing, manage the wound and provide sustained supportive care. The source does not identify a wound, so none should be invented; a search for a plausible portal of entry is part of the assessment.

In historical practice, a quiet, darkened environment and gentle handling aimed to reduce reflex provocation of painful muscle spasms. Trismus made oral feeding difficult, while generalized rigidity and opisthotonus could threaten breathing and exhaust the person. A wound or retained material needed inspection and appropriate local care. Nutrition and fluid support were essential because the illness could outlast a single dramatic paroxysm. Forcefully attempting to open the jaws or repeatedly provoking muscle spasms to “test” them would add danger.

Period treatment tried to suppress the motor manifestations with opium, chloroform and other sedating remedies. The literature contains reports of apparent success, including a report published in November 1866 describing traumatic tetanus. A single survival cannot establish that its mixture of interventions neutralized the cause, especially when case severity and the natural course varied.^[ref] Apparent relaxation during anaesthesia also does not prove eradication of the process producing the muscle spasms.

Modern correction: the problem is toxin-mediated loss of inhibitory control, so treating visible muscle spasms alone is incomplete. Clostridium tetani in a suitable wound can produce tetanospasmin. Treatment includes tetanus immune globulin to neutralize toxin that has not yet bound to neural tissue, wound cleaning and removal of devitalized tissue, and appropriate antibiotics. The immune globulin does not reverse toxin already bound at nerve endings, which explains the need for prolonged supportive care despite prompt treatment.^[ref]

Sedation and muscle-relaxing therapy control muscle spasms, with airway management and assisted pulmonary ventilation when needed. Marked autonomic instability may require additional intensive care. Feeding, hydration and prevention of complications must continue during recovery. Clinical recovery from tetanus does not confer dependable immunity: vaccination is still required.^[ref] For established disease, prophylactic wound advice alone is therefore insufficient, and neither historical chloroform inhalation nor an opiate mixture substitutes for the modern treatment bundle.