272 TETANUS 



found that where antitoxin had been used it had a distinct 

 retarding influence upon these changes. They found like 

 lesions in the spinal cord of a human subject dead of tetanus. 

 Very similar results have been obtained by Matthes, Westphal, 

 Goebel and others. The lesions point to the anterior horns of 

 the spinal cord as the primary seat or origin of the tetanic con- 

 tractions. The changes pointed out above are said by 

 Moschowitz to be characteristic of tetanus and constantly 

 found. The motor ganglia cells of the anterior horns of the 

 spinal cord seem at present, therefore, to be the most likely 

 source of the spasms, due apparently to a specific afBnity 

 between those cells and the tetanus toxin. It is possible to 

 explain also the local spasms on this hypothesis as the toxin 

 elaborated by the nerves terminating in the affected region. 

 The experiments of Tizzoni and Cattani suggest the possibility 

 of such a theory. There is, however, need for further investi- 

 gation on this subject. 



A considerable number of lesions may be found elsewhere 

 in the body, none of which can be considered as characteristic 

 of the disease, but which are secondary to the tonic contrac- 

 tions. The blood, owing to lack of oxidation, may be dark 

 colored, tarry, of a greasy appearance and tardy in coagula- 

 ting. There may be numerous ecchymoses and sanious exu- 

 dates in the subserous and mucous membranes. The lungs 

 may be variously affected according to the extent of the trouble 

 with the respiratory muscles. Thus congestion, edema, 

 hemorrhages, pneumonia, emphysema and hypostatic conges- 

 tions have been described. In the heart there are usually epi- 

 and endocardial hemorrhages. The muscles may contain 

 hemorrhages. The fibers of the muscles may show cloudy 

 swelling, a loss of the transverse striae and changes in the 

 nuclei. The liver may be swollen and abnormally yellow in 

 color. The hepatic cells often show fatty degeneration. The 

 spleen is often swollen, it may be engorged with blood or soft 

 and flabby. The kidneys may or may not show degenerative 

 changes. The bladder is usually distended with urine and its 

 mucous membrane is often sprinkled with ecchymoses. The 



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