TETANUS. 



tice to bring on a new attack. The inability to swallow, and the spas- 

 modic seizures induced by every effort to drink, create a certain resem- 

 blance between tetanus and hydrophobia. The paroxysms are of 

 variable duration. At first they are brief, but at the height of the 

 disease they may continue for a quarter of an hour, or even an hour, 

 ere the remission set it. Consciousness and the intellect generally 

 remain unimpaired until the last in this frightful malady, nor are many 

 of the other functions materially deranged. The unhappy patient 

 suffers from hunger and thirst, which he is unable to relieve. As in all 

 other violent muscular exertion, the skin is bedewed with sweat, and 

 the pulse is frequent and small. The enormous elevation of the tem- 

 perature, first pointed out by Wunderlich, is a matter of great interest. 

 Now and then it has been observed as high as 110 F., and immedi- 

 ately after death a further rise has been observed almost up to 112 F. 

 [This may be due to the muscular activity. Leyden and others 

 have shown that the same elevation of temperature occurs in tetanus 

 artificially induced in dogs. But similar rises are said to occur after 

 injury of the cervical medulla and other cerebral and spinal diseases 

 of the warmth-producing centres ; as in J. W. Teale's case, where 

 the temperature was 108-122 for some weeks, as witnessed by 

 several physicians.] The bowels are usually somewhat constipated, 

 and sleep, though ardently longed for, is impossible. Another source 

 of anguish, as well as of the greatest danger, consists in the derange- 

 ment of the respiration. There is no obstacle to the entrance of the 

 air, but, as Watson aptly remarks, the chest is compressed as in a vice, 

 and respiration is made extremely difficult by reason of the rigidity 

 of the muscles. There are instances where the victim perishes only a 

 few hours after the outbreak of the disease. In such cases, the spas- 

 modic contraction of the diaphragm and other respiratory muscles so 

 increases as to completely arrest respiration and cause suffocation. 

 The majority of patients are not relieved from their sufferings so soon. 

 For three or four days, the cramps, and the frightful pain and dread of 

 suffocation which accompany them, continue to increase in duration 

 and frequence, the remissions becoming more and more imperfect ; 

 until the sufferer expires, either poisoned by carbonic acid resulting 

 from the imperfect manner in which respiration is carried on, and from 

 the augmentation in the consumption of the oxygen, or else dying 

 during some very severe paroxysm, through sudden and absolute inter- 

 ruption to the respiration. Sometimes the breathing is not so much 

 interfered with as to cause death from lack of oxygen. The disease 

 may then go on for weeks ere the patient, in a state of extreme emacia- 

 tion, and exhausted by privation of nourishment, succumbs to starvation. 

 Recovery is extremely rare. Transitory remissions, in which the 



