452 



Tetanus. 



gaseous exchanges in the lungs are not sufficient in spite of 

 the increased respiration and soon there develop symptoms 

 of impaired oxidation of the blood, whenever the spasm is 

 continuous, such as cyanosis of the mucous membranes, 

 hyperemia aud later acute edema of the lungs with rales over 

 the trachea and thorax. Breathing is frequently stertorous 

 or groaning in nature, and sometimes one may observe on 

 inspiration a whistling noise due to the spasm of the laryngeal 

 muscles. Aspiration of mucus or saliva or forcible administra- 

 tion of drugs may easily cause a pneumonia, almost always 

 of gangrenous character and with lethal result. 



The heart action does not vary from the normal in the 

 beginning of the disease, and in light cases it may remain 

 unchanged throughout ; the pulse, however, is small, the arterial 

 walls tense. In severe cases the heart beat becomes very fre- 

 quent and finally throbby, especially towards the fatal end of 

 the disease. 



Internal temperature is increased in severe cases only and 

 then only on the approach of death, or when an inflammation 

 of an internal organ has become associated (pneumonia) or 

 when general septic infection occurs. Aside from such cases 

 the temperature rises in uncomplicated cases only one or two 

 days or even only a few hours before death, increasing rapidly, 

 and reaching 42-43° C. immediately before death (Fig. 71).. 



Fig. 71. Fever curve in tetanus with post-mortem rise of temperature. 



The increase of temperature' continues after death, and in two hours attains 

 45 °C. The cause of this increase in body temperature, first observed in the human 

 cadavfir by Wunderlich, is found in the amount of heat which is produced by the 

 powerful muscle contraction which increases after death to some extent and then 

 relaxes, for similar post-mortem, signs have been observed after poisoning by strych- 

 nine as well as after electrical irritation of the spinal cord (Leyden). 



