4 Paschkie in some recent experiments found that the sulphocyanide of sodium applied in small quantities caused a tetanic state more lasting than that caused by strychnia.
This theory is as yet unsupported by any positive facts. Neither septic element nor peculiar microbe has been discovered.5 Failure has attended all efforts to produce the disease in animals by injecting into them the blood of tetanics. There is no testimony worthy of acceptance of the direct transmission of the disease to those, either healthy or wounded, coming in contact with the tetanic patient; nor can much weight be attached to such reports as that of Betoli of individuals being attacked with it who had eaten the flesh of an animal dead of it.
5 Curtiss of Chicago thought that he had found a special organism, but further investigation showed that it was present in the blood of healthy members of the family and in the water of a neighboring pond.
The ordinary absence of fever has been thought to prove the incorrectness of this theory, but increased body-heat is not a symptom of rabies or strychnia-poisoning, of the tetanic state following the injection of ptomaïnes, or of cholera—a disease very probably dependent upon the presence and action of a bacillus. Martin de Pedro, regarding the affection as rheumatic in character, located it in the muscles themselves, there being produced, through poisoning of the venous blood, a muscular asphyxia.
MORBID ANATOMY.—The pathological conditions observed upon autopsy in the wound, the nerves, the central organs, and the muscles, have been so various and inconstant that post-mortem examinations have afforded little or no definite information respecting the morbid anatomy of the disease. Many of the reported lesions have unquestionably been dependent upon cadaveric changes or defective preparation for microscopic study. The wound itself has been found on the one hand healthy and in due course of cicatrization,6 on the other showing complete arrest of the reparative process (“the sores are dry in tetanus,” wrote Aretæus),7 or even gangrenous, with pus-collections, larger or smaller, in its immediate vicinity, usually in connection with retained foreign bodies.
6 Of one of Hennen's cases it is reported that “the life of the patient and the perfect healing of the wound were terminated on the same day.”
7 Morrison seventy years ago wrote: “Wounds from which there is a copious discharge of bland pus are seldom or never followed by this disease;” and as a rule this is true.
The nerves in and about the injured area have often been found reddened and swollen, their neuroglia thickened and indurated, and blood extravasated at various points. At times, even when to the naked eye healthy, microscopic examination has shown one or a few of the constituent bundles inflamed. But repeatedly the most thorough search has failed to find any departure from the normal state, and the same appearances of congestion and inflammation are not seldom observed when there has been no tetanic complication. In an interesting case reported by Michaud the sciatic in the uninjured limb presented the same neuritic lesions as that of the wounded side.
In the cord and the medulla vascular congestion has been the condition most generally seen, associated not infrequently with hemorrhages and serous effusions—a condition occasionally absent, and when present due, it is probable, in great measure, perhaps wholly, to the muscular spasms, or consequent in part upon post-mortem gravitation of the fluids. Increase in the amount of the connective tissue of the white columns of the cord (thought by Rokitansky to be the essential lesion of the disease); disseminated patches of granular and fluid disintegration (to which Lockhart Clarke called attention in 1864); atrophy of the cells, especially those of the posterior gray commissure; nuclear proliferation; changes in the color, form, and chemical reaction of the ganglion-cells; dilatation and aneurismal swellings of the vessels, with development of granulation-masses in their walls; and changes in the sympathetic ganglia,—such have been the reported lesions. But each and every one has at times been absent—at times been discovered in the bodies of those dead of other diseases. Some of the changes have without doubt been produced after death; some perhaps have been but errors of observation.