TIIK BACILLUS AM) Till-: BACTERIOLOGY OF TETANUS 231 



so long as a fatal dose of poison has not been taken up by the nerves. 

 After tli is has occurred an action of the antitoxin can only then be looked 

 for when it is injected directly into the nerve substance. 



So long as the toxin circulates in the blood it is neutralized by anti- 

 toxin in about the same proportion as in test-tube experiments. By 

 means of intravenous injections of antitoxin Ransom was able to render 

 the blood free from toxin in a very few minutes. According to Marie 

 and Morax toxin injected into the muscles is already demonstrable in 

 the nerve tissue at the end of one and a half hours i. e., it has already 

 entered the channel, where it is no longer reached by the antitoxin. 

 There must, however, be a condition or locality in which the toxin can 

 still be neutralized by means of large doses, though with difficulty. 

 This is indicated among other experiments by some older researches 

 of Donitz. This observer injected various rabbits intravenously each 

 with 1 c.c. of a toxin solution containing twelve fatal doses. Thereupon 

 he determined the dose of antitoxin which, when intravenously given, 

 would neutralize this poison after various intervals of time. The anti- 

 toxin was of such a strength that in test-tube experiments 1 c.c. of a 

 1 : 2000 solution just neutralized the amount of toxin employed. He 

 found that at the end of two minutes double the dose required in vitro 

 would still neutralize the poison; at the end of four minutes about four 

 times the dose was required, and at the end of eight minutes ten times. 

 Wlien one hour had been allowed to elapse forty times the original 

 dose just sufficed to protect the animal from death, but not from sick- 

 ness. In order to explain these results, the correctness of which has 

 been confirmed bv many analogous observations, the conception "loose 

 union of toxin" has been introduced. By this is meant a state of 

 union between toxin and susceptible cell constituent which can still 

 be disrupted by means of large doses of antitoxin. In this particular 

 instance we do not need to make use of this conception, for the 

 reason that the tetanus toxin is not at all combined during the first hour, 

 being engaged at this time in traversing the peripheral nerve paths. 

 Personally, I should regard it as more probable that the interval during 

 which the toxin can still be neutralized, though with difficulty, corre- 

 sponds to that time during the passage of the toxin in which after leav- 

 ing the capillaries the poison is held up in the fine interstices of the 

 connective tissue which it must penetrate before it can be taken up by 

 the nerves. 



Results of the Antitoxin Treatment in Tetanus. Tetanus is a com- 

 paratively rare disease both in man and animals, though in some 

 localities it is more common than in others. In New York City there 

 are usually fifteen to thirty cases following every Fourth of July. Most 

 of them are caused by" infection through blank-cartridge wounds. 

 Recovery sometimes follows from the ordinary symptomatic treatment 

 or without treatment at all, so that the statistics of cures of the disease 

 by the injection of antitoxic serum must be very carefully sifted before 

 they can be accepted as reliable. Lambert, who a few years ago 

 made an exhaustive study of tetanus, states that in a total of 114 cases 



