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the axis cylinder substance; the latter found the toxin car- 

 ried to the central nervous system solely by the motor 

 nerves, the action depending upon the integrity of the 

 axis cylinder. They believe that the toxin is absorbed 

 by the axis cylinder endings, and reaching the correspond- 

 ing spinal nerve center by that route spreads to the cor- 

 responding center in the other half of the cord and out- 

 ward, 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 succeeds the intramuscular 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 distribu- 

 tion 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 resulting 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, de- 

 pending upon the centric action. The latter are the more 

 dangerous for the sufferer. 



The lockjaw or trismus and the opisthotonos that are so 

 characteristic of the affection depend, according to Zupnik's 

 view, upon a loss of equilibrium among the muscles affected. 

 They occur only in descending tetanus and depend upon 

 spasm of muscle without equally powerful opposing groups. 

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



