TETANUS LOCKJAW 615 



between tetanus and strychnin poisoning which show very 

 similar symptoms. In strychnin poisoning the spasms develop 

 more rapidly, and are of much greater severity and the mem- 

 hrana nictitans is not usually affected. .The extremely in- 

 creased reflex excitability in strychnin poisoning as compared 

 to tetanus will also serve to differentiate them. 



(6) Tetanus may also be mistaken for cerebrospinal menin- 

 gitis, but in the latter disease other symptoms, such as dulness 

 and paralysis of certain cerebral nerves, are present which 

 will assist in the diagnosis. 



(c) Muscular rheumatism is differentiated by the absence 

 of reflex excitability; the muscles are painful and swollen 

 rather than contracted as in tetanus. 



(d) There are quite a number of conditions (rabies, eclamp- 

 sia, epilepsy, articular rheumatism, etc.) which show some 

 symptoms of tetanus, but there are always other symptoms 

 present which are sufficient for differentiation. 



Prognosis. The prognosis in dogs, providing the symp- 

 toms are localized, is quite favorable. Should the disease, 

 however, become general it is unfavorable. The course in 

 the dog is usually subacute or chronic. 



Treatment. Dietetic. When trismus is present, prevent- 

 ing the animal from taking food, rectal feeding is recom- 

 mended. Concentrated beef broth at body temperature is 

 perhaps best. Two to four ounces should be given 3 to 4 

 times daily. During the later stages milk can be allowed as 

 they will lap it in small quantities. 



Medical. Small and repeated doses of morphin sulphate 

 (0.05-0.2) once or twice daily to control spasms of the muscles; 

 or chloral hydrate administered per rectum (1 to 4 with acacia 

 and glycerin), using 6.0-12.0 of the mixture once or twice 

 daily. Subcutaneous injections of a diluted carbolic acid 

 solution have been recommended, but are of doubtful value. 



Serum. Tetanus antitoxin has proved to be of greater 

 value as a prophylactic than a curative treatment. Large 

 doses might be used, 1500 units daily for three to four days. 



Surgical. In case a wound is found indicating the focus 

 of infection, it should be thoroughly curetted and strong 

 antiseptic solutions applied (mercuric chlorid 1 to 1000; 

 carbolic acid solution 5 per cent.). 



