Another characteristic feature of the disease is the reflex irritability, or hyperesthesia, by which these convulsive attacks apparently are produced. Into this condition the patient falls more or less rapidly within the first day after the inception of the disease, and to such a height may it be augmented that the slightest movement in the room, jarring of the bed, or displacement of clothing, even noise or a flash of light, may immediately bring on a convulsion. Rupture of muscles has been reported during some of these violent convulsions.
Fig. 18
Characteristic tetanic spasm in a rabbit twenty-six hours after inoculation with pure culture of tetanus bacilli. (Tizzoni and Cattani.)
During the course of this disease the jaws are so fixed that patients speak with extreme difficulty and the tongue cannot be protruded. The mind is clear until the end. The pain is rather the acute soreness due to intense muscle strain. There is spasm of the sphincters, by which urine and feces are often retained. There is nothing characteristic about the temperature, which is seldom much augmented. Attempts to swallow give pain, and are resisted because of the renewed muscle spasm which is likely to follow the irritation inseparable from the act itself. As the result of spasm of the glottis peculiar respiratory sounds may be noted.
Until the last only the voluntary muscles are involved. Finally, however, there are spasms of the accessory respiratory muscles and of the diaphragm. Death is usually produced by involvement of these muscles analogous to those of the others, and results usually from apnea or suffocation. During the last hour or two perspiration may be copious and the temperature may rise.
Chronic tetanus is characterized throughout by a milder and much more prolonged series of symptoms. The period of incubation is much longer, and, while the general program of the acute form is adhered to, it is of less severe degree and is spread over a longer time; in fact, cases covering two months or more are reported. In chronic tetanus the prognosis is much more hopeful than in the acute form.
The wound is but slightly, if at all, affected. In some cases it will be found to have healed before the onset of the disease. If suppurating or open, its evidences of repair will be found unsatisfactory and some indications of septic infection may be noted. Pricking or needle sensations may be subjective phenomena.
Prognosis.
—Prognosis is almost invariably bad; if patients live more than five or six days it is thereby improved.