TOXINS AND ANTITOXINS 297 



5. Invasive Power. — While CI. tetanus has no invasive power 

 and, therefore, remains localized at the point of entry, the or- 

 ganisms causing gas gangrene rapidly invade the tissues and blood 

 stream and may become widely distributed in the body, 



6. In experimental gas gangrene the areas of gangrene produced 

 by pure cultures of CI. welchii, CI. sejyticimi, and CJ. ocdemati- 

 ens exhibit characteristic differences according to Robertson 

 (1929) that can be recognized grossly and microscopically. 



Difference in Pathological Picture. — CI. welchii and CI. 

 septicum produce relatively large amounts of gas in the tissues 

 while gangrene caused by CI. oedcmatiens shows little, if any, crepi- 

 tation. The edema fluid due to CI. welchii is slightly pink in color, 

 that of CI. septicum deep red, while CI. oedematiens produces 

 an extensive colorless gelatinous edema which, when the infection 

 is very rapid, may become pink. In CI. welchii infection the muscles 

 are friable, soft, and have a sodden digested appearance, and a 

 sour rancid odor is evolved. There is no blackening and no sug- 

 gestion of putrefaction. In gangrene due to CI. septicum the 

 skin and muscles are not friable nor do they appear digested. 



7. Effect of Toxins on Heart and Adrenals. — The effect of 

 these toxins upon the heart and adrenals has been studied ex- 

 tensively. Acute death in cases of gas gangrene is said by Robert- 

 son (1929) to be due to heart failure and the exhaustion of the 

 su]irarenal glands. The latter, also, occurs in fatal gangrene due 

 to CI. septicum. Robertson and Dale (1920) analyzed the 

 toxic action of CI. septicum by means of a kymograph. Robert- 

 son cites this work and quotes Dale's opinion that the toxin exerts 

 both a pressor action and also a poisoning of the heart muscle. 

 The action of the toxin of CI. oedematiens has not been studied 

 extensively. 



8. Therapeutic Value of Antitoxins. — To be effective, poly- 

 valent antitoxin should be administered before symptoms have 

 appeared or very early in the disease. As a therapeutic agent 

 it is injected intravenously, intramuscularly, and infiltrated lo- 

 cally. Unless the serum contains antitoxins for each of the an- 

 aerobes causing the gangrene, it will be ineffective since the one 

 or more whose toxins are not neutralized will still be active. The 

 effect of sulfanilamide and related compounds upon CI. welchii, CI. 



