410 TETANUS. 



difficulty in swallowing, with stifihess of the back part of the 

 neck, and slight protrusion and elevation of the nose. 



On approaching him for the purpose of examination he is 

 easily excited, and twitching of the facial muscles may be 

 observed ; while, should the hand be brought in contact with 

 the nose or lips, or an attempt be made to open the mouth, the 

 head will be rapidly elevated, and the eyeballs spasmodically 

 withdrawn within the orbit from the action of the muscles of 

 the ball ; at the same time the membrana nictitans is rapidly 

 projected over the surface of the eye. The breathing is very 

 early accelerated, but the pulse is not -at first materially 

 increased in number, although altered in character, being rather 

 . hard and incompressible. The temperature in milder cases is 

 not much elevated, while in the severe, and such as terminate 

 fatally, it may give very high readings. In the earliest stages 

 of the disease, or it may be all through the seizure in less acute 

 cases, the ability to open the mouth is not entirely gone, the 

 movement being only limited; in severe cases this movement be- 

 comes rapidl}^ restricted until the jaws are completely locked. 



This ability to open the mouth all through the disease serves 

 as a very good criterion whereby we may judge of the mitiga- 

 tion or increase of the spasms ; although, as a rule, earliest 

 observed in the facial and cervical muscles, and those of 

 deglutition and mastication, this spastic condition rapidly shows 

 itself throughout the entire muscular S3^stom. AVhen fully 

 developed the position of individual parts, as the head, tail, and 

 limbs, is regulated by the more powerful muscles which act 

 upon them. The neck and head are much elevated, the nose 

 persistently protruded, Avith nostrils dilated and immovable, 

 the angles of the mouth somcAvhat retracted, the eyes watchful 

 and brilliant, with continual retraction of the eyeballs Avithin 

 the orbit, and a rapidly recurring j^rotrusion of the cartilago- 

 nictitans over the globe. The muscles of the back feel, as well 

 as look, rigid ; the tail is elevated, and steadily agitated by a 

 tremulous spasmodic movement. The limbs, forcibly extended, 

 are kept wide apart ; and any attempts at locomotion are per- 

 formed with difficulty, and with a peculiar straddling stilty 

 gait and evident pain. The bowels are confined, desire for food 

 and water is never entirely absent, while attempts to eat are 

 often folloAved with aggravation of symptoms. 



