Tetanus. 297 



Gumprecht and Goldscheider claim that the poison reaches the 

 spinal centres by way of the nerve trunks basing the conclusion 

 on the observation that the spasms sometimes remain for a time 

 more marked on that side of the body on which the wound or in- 

 oculation was made. Absorption through the circulation also is 

 conceded. 



Courmont and Doyon claim that the product of the bacillus 

 tetani only operates as a ferment, which produces in the blood 

 the real tetanizing agent, basing the conclusion on an apparent 

 delay in its action, in man, as compared with strychnia, and on 

 the prompt action of the injected blood of a tetanic animal in 

 which this poison is presumably preformed. It should be noted, 

 however, that the disease in man is only seen after accidental in- 

 oculation of the bacillus, and that time must be allowed for the 

 increase of the microbe. 



Vaillard and Vincent have shown that the promptitude and 

 certainty of the result depend on the age of the culture employed. 

 A culture of 5 days in bouillon at 20 to 22 C. will not harm a 

 Guinea pig in a hypodermic dose of 0.25CC to 0.5CC A culture 

 of 20 days old is deadly. 



The action on the nerve cell of the spinal cord has been investi- 

 gated by Goldscheider and Flatau, who found degeneration of 

 the chromatin granules within a short time after inoculation. 

 (Centr. fur Allg. Path. Anat. 1897). W. K. Hunter found that 

 the ganglion cell stained more diffusely than normal cells. There 

 were also some capillary dilatation and punctiform haemorrhages 

 in certain cases (Brit. Med. Jour. 1897). 



Pechoutre examined the lumbar enlargement of tetanic rabbits, 

 by Nissl's method and found the following lesions in the motor 

 cells of the anterior horns : 1st. A partial or total disappearance 

 of the distinct outer marginal line ; enlargement of the cell and 

 pericellular space ; diffuse coloration of the acromatic substance ; 

 a disappearance of the regular concentric disposition of the gran- 

 ules of Nissl which were in part reduced to a fine powder ; 2d. 

 Hncrease of nucleus and nucleolus. 



Others have observed encrease of the cerebro-spinal fluid, 

 thickening of the ependyma, nuclear proliferation in the neuroglia, 

 and softening of the cord, but in many cases no appreciable 

 lesions in the nerve centres have been found, and none can be 



