SYMPTOMS. — COURSE AND TERMINATIOX. 411 



During the course of tlie disease, although the muscular 

 spasms are contimious and not intermittent, there will yet be 

 noticed regularly recurring periods of exacerbations, and more 

 rarely of remission. These exacerbations are easily induced — 

 the slightest noise, the sudden flashing of light into a previously 

 darkened stable, hurriedly and roughly opening a door, a 

 sudden attempt to take hold of the animal ; in short, rough or 

 rapid movement in any way, or even talking loud, are sufficient 

 to develop the most distressing paroxysmal spasms. During all 

 these accessions the animals appear to sufter intensely, the 

 breathing becomes laboured, and the body damp from perspira- 

 tion ; while in severe cases they may stagger, lose their equili- 

 brium, and fall to the ground. The pulse, not much affected 

 at first, or rather firm and incompressible, gradually loses this 

 character, becomes rapid, small, and feeble, death appearing to 

 ensue from continued spasm of the muscles of respiration, or 

 general exhaustion, consequent on the continued excitation 

 of the nervous system and Avant of nutrition ; or it may be 

 that spasm has seized on the muscular fibres of the heart. 



Course and Termination. — Although of more frequent occur- 

 rence in some districts, and during certain seasons, than in 

 other localities and at different times, tetanus may everywhere 

 and on all occasions be regarded as a serious and rather fatal 

 disease. Occasionally of a mild character, and occupying in 

 the passage through its various phases a rather lengthened 

 period, it is ordinarily observed of a type which may be regarded 

 as either acute or subacute. In the former, cases which are 

 characterized from the accession of the diagnostic symptoms 

 of tonic muscular spasms to their full development, by rapidly 

 recurring exacerbations, febrile disturbance, high temperature, 

 much restlessness and pain, the percentage of recoveries is 

 exceedingly small. 



When, however, the tetanic spasms do not undergo marked 

 augmentation during the first week, general disturbance not 

 being excessive, nor the temperature above 103° F., restlessness 

 and pain not being attractive features, the prognosis is favour- 

 able. It is not a common feature of tetanus that, during its 

 continuance, partial recovery should take place, to be succeeded 

 by renewed or intensified motorial function. The usual cha- 

 racter of development is that of quiet but steady progress — in 



