346 Tetanus 



field,* thinking that it might be useful in the treatment of certain 

 paralytic affections, injected a minute quantity of it into the calf 

 of his leg and experienced the severe spasmodic local effects of the 

 poison for twelve hours. 



It has been the belief of most physiologists that tetanus toxin 

 acts solely upon the motor cells of the spinal cord, and causes the 

 tonic spasms as strychnin does. The affinity of the toxin for the 

 nervous tissues has been made the subject of careful investigations by 

 Marie and Moraxf and Meyer and Ransom. J The former found 

 that the absorption of tetanus toxin took place partly through the 

 peripheral nerves because of specific affinity between the toxin and 

 the axis cylinder substance; the latter found the toxin carried to the 

 central nervous system solely by the motor nerves, the action depend- 

 ing upon the integrity of the axis cylinder. They believe that the 

 toxin is absorbed by the axis cylinder endings, and reaching the cor- 

 responding spinal nerve center by that route spreads to the corre- 

 sponding center in the other half of the cord and outward, resulting 

 in generalized tetanus. When intoxication is produced through the 

 circulation, the poison is taken up by the nerve endings in all parts 

 of the body, and the disease is not localized, but general. Antitoxin, 

 unlike the toxin, does not travel by the nerve route, but is found only 

 in the blood and lymph. Zupnik has brought forward evidence 

 that this view is incorrect and that there are two distinct actions 

 caused by the toxin. He differentiates between tetanus ascendens 

 and tetanus descendens. The former always follows the intramus- 

 cular introduction of the toxin, and depends upon its direct action 

 upon the muscle itself. It explains the familiar phenomenon of 

 rigidity making its first appearance in that member into which the 

 inoculation was made. The ascending tetanus gradually ascends 

 from muscle to muscle. He thinks the absorption of the poison by 

 the muscle-cells depends upon their normal metabolic function, as 

 when their nerves are severed, the fixation of the toxin and the 

 occurrence of the tonic spasm does not occur. 



Tetanus descendens results from the entrance of the toxin into the 

 circulation from the cellular tissue and its distribution in the blood. 

 Under these conditions Zupnik believes it acts upon the central 

 nervous system, especially upon the spinal cord, manifesting itself 

 in extreme reflex excitability with irregular motor discharges result- 

 ing in clonic spasms. 



There are, therefore, two forms of spasm in tetanus: the tonic 

 convulsions, seeming to depend upon local action and fixation of the 

 toxin, and the clonic convulsions, depending upon the centric action. 

 The latter are the more dangerous for the sufferer. 



* "Therapeutic Gazette," March 15, 1897. 



t"Ann de 1'Inst. Pasteur," 1902, xvi, p. 818; and "Bull, de 1'Inst. Past.," 

 1903, i, p. 41. 



t "Arch. f. exper. Path. u. Pharmak.," 1903, XLIX. 

 "Wiener klin. Wochenschrift," Jan. 23, 1902. 



