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As the toxin spreads it causes both motor hyper-tonus and hyper-excitability, which accounts for the tonic contraction and the clonic spasms characteristic of tetanus. [Illustration: FIG.
The muscles affected are usually in the trunk and in the limbs, and not in the toes and hand; occasionally the movements are tonic as well as clonic; the degree of spasm varies greatly, and according to Gray may sometimes be so violent as to throw the patient down or out of the chair. Saltatoric spasm is an extremely rare condition, first observed by Bamberger in 1859.
When the thoracic muscles, including the diaphragm, are thrown into spasm, the patient experiences a distressing sensation as if he were gripped in a vice, and has extreme difficulty in getting breath. Between the attacks the limbs are kept rigidly extended. The clonic spasms may be so severe as to rupture muscles or even to fracture one of the long bones.
The calf, hip, knee, and back-muscles are affected by clonic spasm, causing springing or jumping movements when the patient attempts to stand. The disease is transient, and there are no mental symptoms. Progressive muscular atrophy has been observed as far back as Hippocrates, but it is only in recent times that we have had any definite knowledge of the subject.
In hydrophobia a history of having been bitten by a rabid animal is usually forthcoming; the spasms, which are clonic in character, affect chiefly the muscles of respiration and deglutition, and pass off entirely in the intervals between attacks.
Certain accessory movements, which tend to become stereotyped in each individual and which consist of tonic and clonic conditions of other muscles not involved in normal speech, accompany these asynergies.
By all accounts they come on usually after quarrels, disagreements or disappointments. They are not accompanied by blanching, by clonic or tonic movements of any kind, they last for uncertain periods ranging from five minutes to an hour or more, and consciousness does not seem to be totally lost. In addition she has vomiting spells, these likewise occurring when balked in her desires.
To this permanent tonic contraction of the muscles there are soon added clonic spasms. These spasms are at first slight and transient, with prolonged intervals between the attacks, but rapidly tend to become more frequent, more severe, and of longer duration, until eventually the patient simply passes out of one seizure into another.
However, the clonic nature of the spasm should prevent such an error. If they are lying down, it is difficult to get them to arise, and if they do so, they show marked symptoms of pain for some time after rising. The position of the feet is of great importance and offers symptoms that should not be overlooked.
The sounds were described as crackling, and seemed to depend on movements of the arch of the palate. Kauffmann expresses the opinion that the noises were due to clonic spasm of the tensor velum palati, and states that under appropriate treatment the tinnitus gradually subsided.
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