Symptoms. 453 



Ingestion of food is hindered by the trismus, in spite of 

 a good appetite. Patients repeatedly reach for food, chew 

 the morsels with a lot of noise and finally swallow them with 

 difliculty, or the food remains in the mouth and is later expelled 

 by cough. The food particles which accumulate in the mouth 

 are mixed with saliva and undergo fermentation or decomposi- 

 tion, decolorizing the saliva and imparting to the exhaled air a 

 fetid odor. Liquid food is more easily taken, although sometimes 

 even the drinking of water becomes impossible, in spite of every 

 effort, regurgitation being often observed. The tongue is usually 

 coated with a thick, dirty-grayish deposit, the margins showing 

 the imprint of the teeth and frequently superficial injuries. 

 Peristalsis is suppressed, defecation delayed on account of the 

 tension of the abdominal walls, and only a few fecal balls are 

 evacuated at a time. 



Micturition is also delayed and the urine is more concen- 

 trated, with increased specific gravity as a result of the pro- 

 longed retention in the -bladder as well as reabsorption of the 

 aqueous constituents. In completely suppressed ingestion of 

 food the reaction is acid and the urine contains debris and 

 oxalate crystals in large amounts (Friedberger). 



According to Tabusso's experiments the blood contains heterolysins, also 

 auto- iso- and heteroa,gglutinins, while the freezing point is slightly diminished 

 (an average of (5.535 against 0.558 for normal horse serum), whereas in other 

 instances where dyspnea and asphyxia are present the molecular concentration is 

 increased. 



In fatal cases the patients, which have hitherto been 

 constantly standing, suddenly break down, fall to the ground 

 and die in a few hours under progressive increase of the 

 muscular contractions. The immediate cause of death is some- 

 times exhaustion, or suffocation, at times also a hypostatic 

 or traumatic pneumonia. 



In localized tetanus the mugcle spasm is confined to certain 

 parts of the body, and usually to those in which the infection 

 occurred. When the spasm affects the muscles of mastication, 

 the course of the disease is usually unfavorable on account 

 of impaired nutrition; in other cases the disease occasions as 

 a rule merely a transitory disturbance of function. When the 

 partial tetanic spasm remains local to the end, it is usually 

 accompanied by light symptoms and the contraction of the 

 affected muscle groups does not develop to as high a degree 

 as in generalized tetanus. In most cases the localized tetanus 

 is the incipient stage of general infection. 



The clinical picture of the disease varies but slightly ac- 

 cording to the species of animals affected, and deviations in the 

 complications are usually the only changes observed. 



In cattle bloating and distention of the left flank develop 

 on account of the suppression of the movements of the paunch 

 and of rumination due to spasms of the abdominal muscles. The 

 patients show a more pronounced apathy or dullness and their 



