4O2 Tetanus 



to mice in doses of 0.00000005 gram. Lambert * considers 

 the tetanus toxin to be the most poisonous substance that 

 has ever been discovered. 



Like most of the bacterial toxins, the tetanus poison is 

 only effective when produced in or injected into the tissues 

 and absorbed into the circulation. It is harmless when 

 given by the digestive tract, Ramon f having administered 

 by the mouth 300,000 times the fatal hypodermic dose 

 without producing any symptoms. The toxin seemed to 

 pass out with the feces. 



The local action of the toxin is very painful and asso- 

 ciated with spasm of the muscular fibers with which it 

 comes in contact. Pitfield.J: thinking that it might be 

 useful in the treatment of certain paralytic affections, 

 injected a minute quantity of it into the calf of his leg 

 and experienced the severe spasmodic local effects of the 

 poison for twelve hours. 



It has been the belief of most physiologists that tetanus 

 toxin acts solely upon the motor cells of the spinal cord, and 

 produced the tonic spasms as strychnia does. 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. 



* "New York Med. Jour.," June 5, 1897. 



t "Deutsche med. Wochenschrift," Feb. 24, 1898 



t "Therapeutic Gazette," March 15, 1897. 



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



