QUARTERLY CHRONICLE. 57 
thing has been ascertained of the changes which ensue in 
the condition of the nervous centres. Some of the sympa- 
thetic ganglia have been found inflamed, or more or less hyper- 
zemic ; but these conditions are far from being constant. Swan 
tells us that in one case of tetanus he discovered well-marked 
inflammation of the semilunar ganglia; in another the vascu- 
larity of these ganglia was much increased ; while in a third 
there was enlargement with increased vascularity, not only 
of the semilunar ganglia, but also of those in the chest. 
Some of the ganglia of the abdomen, however, remained 
unaffected. In other cases of tetanus in which the sympa- 
thetic ganglia have been examined, they have been found 
perfectly healthy. 
Of the peripheral nerves in tetanus, many cases of well- 
marked disease have been recorded by different authors. Mr. 
Curling mentions two cases in which the nerves at particular 
spots appeared inflamed. Instances of the same kind have 
been recorded by Pelletier, who believes that in every case of 
traumatic tetanus the disease is due to inflammation, extend- 
ing from the injured nerves to the membranes and sub- 
stance of the spinal cord ;* and Froriep has published seven 
cases of traumatic tetanus, in which there were swelling 
and redness of particular portions of the nerves between the 
wound and the spinal cord.t Of the spinal cord itself, the 
principal abnormal appearances that have been hitherto ob- 
served consist only of hyperzemia of its membranes and sub- 
stance, with occasional effusion of fluid around its surface. 
Having given this brief summary of what is at present 
chiefly known of the pathology of tetanus, I proceed to the 
results of some observations which I lately made on the spinal 
cord in the two following cases which occurred in St. George’s 
Hospital. 
On the 30th of April, 1863, a man fell a distance of twelve 
feet to the ground, by which the skin of the right leg was 
said to be severely bruised. On the 11th of May he com- 
plained of stiff-neck, and some difficulty of deglutition. In 
the night his mouth became quite closed, and he had several 
fits of severe dyspnoea, accompanied by contraction of the 
muscles of the back. On the following day the surface of 
the body became cold and clammy, with large drops of sweat 
on his forehead. When lying supine on the bed, his back 
was so curved that the hand and forearm could be passed 
between it and the bed. He had the risus sardonicus ex- 
* ©Revue Méd.,’ 1827, vol. iv. 
_ + ‘Neue Not. aus dem Gebiete der Natur und Heil Kunde,’ 1837, vol. 
1; NO. .1. 
