MORBID ANATOMY igi 



become more indistinct ; then follows an enlargement and dis- 

 intergration of Nissl's cell-granules with an enlargement of 

 all of the nerve cells. These investigators also found that 

 where antitoxin has been used it had a distinct retarding in- 

 fluence upon these changes. They found like lesions in the 

 spinal cord of a human subject dead of tetanus. Very simi- 

 lar 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 of origin of the tetanic contrac- 

 tions. 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 affinity 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 

 tetanus bacilli is taken up and carried to the spinal cord 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 investigation of 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 contractions. 

 The blood owing to lack of oxidation may be dark colored, 

 tarry, of a greasy appearance and tardy in coagulating. There 

 may be numerous ecchymoses and sanious exudates in the sub- 

 serous and mucous membranes. The lungs may be variously 

 affected according to the extent of the trouble with the respira- 

 tor}' muscles. Thus, congestion, oedema, hemorrhages, pneu- 

 monia, emphysema and hy^postatic congestions have been de- 

 scribed. 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 kid- 

 neys may or may not show degenerative changes. The blad- 



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