Antitoxin 397 



The injection of the toxic bouillon or of the redis- 

 solved ammonium sulphate precipitate, in progressively 

 increasing doses, into animals, causes the formation of anti- 

 bodies (antitoxin) by which the effects of both the tetano- 

 spasmin and the tetanolysin are destroyed. The purely toxic 

 character of the disease makes it peculiarly well adapted for 

 treatment with antitoxin, and at the present time our sole 

 therapeutic reliance is placed upon it. The mode of prepar- 

 ing the serum and the system of standardization are discussed 

 in the section upon Antitoxins in the part of this work that 

 treats of the Special Phenomena of Infection and Immunity. 



Antitoxin. Numerous cases of the beneficial action of 

 antitoxin are on record, but, as Welch* has pointed out, 

 the antitoxin of tetanus has proved a disappointment in 

 the treatment of tetanus. Moschcowitz,f in his excellent 

 literary review of the subject, has shown that its use has 

 reduced the death-rate from about 80 to 40 per cent., and 

 that it therefore cannot be looked upon as a failure. The 

 result of its experimental injection, in combination with 

 the toxin, into mice, guinea-pigs, rabbits, and other animals 

 is perfectly satisfactory, and affords protection against 

 almost any multiple of the fatal dose, but the quantity 

 needed, in proportion to the body-weight, to save an animal 

 from the unknown quantity of toxin being manufactured 

 in its body increases so enormously with the day or hour 

 of the disease as to make the dose, which increases millions 

 of times where that of diphtheria antitoxin increases but 

 tenfold, a matter of difficulty and uncertainty. Nocard 

 also called attention to the fact that the existence of tetanus 

 cannot be known until a sufficient toxemia to produce 

 spasms exists, and that therefore it is impossible to attack 

 the disease in its inception or to begin the treatment until too 

 late to effect a cure. At this point it is well to recall 

 Nocard's experiment with the sheep, in whose blood so much 

 toxin was already present when symptoms first appeared 

 that the amputation of their infected tails could not save 

 them. 



The explanation of this inability of the antitoxin to effect 

 a cure when administered after development of the symp- 

 toms of tetanus is probably found in a ready fixation of the 



* "Bulletin of the Johns Hopkins Hospital," July and August, 

 1895. 



f "Annals of Surgery," 1900, xxxn, 2, pp. 219, 416, 567. 



