456 Tetanus. 



external irritants do not produce a rigidity of muscles in remote 

 parts of the body, while on the other hand muscle paralyses 

 occur in the later course of the disease. 



Clonic spasms are characteristic of epilepsy and eclampsia. 

 In epilepsy these are separated by intervals of freedom from 

 spasms. Tonic spasms are exceptionally observed in single 

 muscle groups and then they are only transitory, while the 

 patients also lose consciousness during the attacks. — In rabies 

 trismus is absent, the ears are not stiff and here paralyses 

 occur later. 



Acute muscular rheumatism, when very severe, occasions 

 a similar spasmodic condition at the parts of the body affected 

 as occurs in tetanus; but here the muscles are painful and 

 appear swollen rather than tense, the reflex irritability is not 

 increased and external irritation causes no . extension of the 

 condition. 



In articular inflammations of the extremities as well as 

 in rickets the stiff gait also reminds one of tetanus, but the 

 changes in the shape of the joints protect against error, while 

 the cause of an apparent trismus resulting from inflammation 

 of the maxillary joint is differentiated by the tenderness of the 

 involved articulation and the laxity of the masseters. 



Finally tetanus must be differentiated from tetany which 

 is produced by traction of certain nerves or adhesion to a 

 cicatrix. As soon as the nerve is freed these symptoms all 

 disappear (Gunning cured the disease in one case by freeing 

 the spermatic cord stump which had grown into the scrotum). 

 Tetanic symptoms are sometimes observed in painful intestinal 

 diseases (Hoffmann observed this repeatedly during four weeks 

 in a horse infested with ascaris). Recovery followed expulsion 

 of the worms. 



Pus from wounds may occasionally reveal spore-bearing tetanus bacilli on 

 microscopic examination, which are mixed with other bacteria (see Fig. 73). . Such 

 material is also suitable for diagnostic inoculations of mice and guinea pigs. 



Prognosis. The course of tetanus is unfavorable in the 

 majority of cases. The mortality varies in horses between 

 55 and 90%, in cattle it is a little lower, in sheep higher and in 

 young animals, especially in lambs, most unfavorable (95 to 

 100%). Gunther, however, saw four out of five colts 8 to 14 

 days old recover. The earlier the symptoms appear after in- 

 fection, the more rapidly the muscle spasm develops with pro^ 

 portionate intensity, the more unfavorable is the prognosis, 

 and a marked locking of the jaw is of bad significance. In 

 a longer incubation and more gradual development of the dis- 

 ease, the prospects are better, and should the animal survive 

 the second week it may most probably *be considered saved if 

 the respiration and nutrition are satisfactory and no complica- 

 tions set in. 



From a prognostic point of view the internal temperature 



