Answers to photo quiz from august issue



  1. What name is given to this facial physical sign?
  2. What is the underlying cause?
  3. What parts of the body are most likely to be the infected foci?
  4. Describe the cardiovascular complications.
  5. What is the risk of sucking out (aspirating) secretions from the trachea?
  6. With what apparently minor symptom might a neonatal case of this condition present?


  1. Risus sardonicus (trismus).
  2. Tetanus caused by Clostridium tetani infection of a wound.
  3. Hands, legs and feet: in neonates the cut umbilicus.
  4. These arise from the disturbance of the autonomic nervous system causing tachycardia, hypo / hypertension, peripheral vasoconstriction and shock. A sudden tachycardia plus hypertension is called an “autonomic storm” and is followed by bradycardia and hypotension. A variety of cardiac dysrhythmias (including ventricular tachycardia) may occur.
  5. Stimulation of the trachea may increase the vagal tone leading to severe bradycardia and even cardiac arrest. This procedure must be carried out very gently.
  6. Difficulty with suckling.

We are grateful to Dr. David Webster for providing this photograph of his experience in Amudat Hospital, Uganda when he was there as Medical Superintendant in the 1960’s.