THE ANAEROBIC BACILLI 747 



diagnostic difficulties, once the disease is suspected. Since the toxin 

 is preformed before ingestion, the symptoms are not long in follow- 

 ing the eating of infected food, coming on usually within twenty-four 

 hours or less. Delays of two or three days, however, may occur, 

 and should not throw out possible positive diagnosis. The earliest 

 symptoms usually consist in a general weakness and lassitude, with 

 fatigue and some headache. Characteristic is the frequent lack of 

 any symptoms pointing to the gastrointestinal canal. Constipation 

 is the rule. Very early in the disease, disturbances of vision may 

 occur which are due to impairment of the muscles of the eye-ball. 

 There is, particularly, involvement of the third cranial nerve, with 

 blepharoptosis, mydriasis, impaired light reflex and diplopia. There 

 may be photophobia. For a detailed discussion of the symptoma- 

 tology, the reader is referred to the Monograph of Dickson. 61 Im- 

 pairment of the pharyngeal muscles may produce difficulties in 

 swallowing with inability to chew, and sluggishness of the tongue 

 with thickness of speech. Absence of temperature is an important 

 feature, and in the early stages there is usually no fever and no 

 change in the heart rate. Fatal cases usually end in death within 

 three to seven days, due either to cardiac failure or terminal 

 asphyxia. In discussing the differential diagnosis, Dickson mentions 

 particularly, poliomyelitis, cerebrospinal syphilis, early stages of 

 bulbar paralysis, belladonna poisoning and methyl alcohol poisoning. 

 The last must be particularly thought of during the present period 

 of drought. 



Specific Therapy. Potent antitoxins may be produced by the 

 treatment of susceptible animals with toxin. Kempner 62 in 1897 

 was the first to experiment on this extensively, using the Von 

 Ermengem strain, and producing antitoxin in goats. The immuniza- 

 tion of small laboratory animals is comparatively difficult, unless 

 minute doses and attenuated toxin is used. The chief studies on 

 these phases of the problem have been made by Forssman and 

 Lunstrom 63 and by Leuchs. 64 More recently, Dickson and Howitt 65 

 have produced potent antitoxins in goats, though their products, 

 they state, were not as powerful as those reported by Kempner and 



61 Dickxon, Monograph of the Rock. Inst., No. 8, July 31, 1918. 



82 Kempner, Zeit. f. Hyg., 26, 1897, 481. 



83 Foreman and Limstrom, Ann. do I' Inst. Past., 16, 1902, 294. 



64 Leiichs, Kollc and Wasserrnann Handb., Second Edition, 4, 939. 

 85 Dickson and Howitt, Jour. A. M. A., 74, 1919, 718. 



