480 ANAEROBIC BACTERIA 



by way of the nerves, while the antitoxin circulates in the blood stream, 

 it is not surprising, as Welch 1 has pointed out, that tetanus antitoxin 

 has been disappointing as a curative agent. Used prophylactically 

 it is very much more satisfactory. Flooding the nerves near the site 

 of inoculation with antitoxin, or the intracerebral injection of anti- 

 toxin in desperate cases is sometimes successful. 2 Tetanus antitoxin 

 has also been administered intraneurally and subdurally in desperate 

 cases. Subcutaneous injection is comparatively inefficient. The sub- 

 cutaneous injection of two hundred or more units at the site of infec- 

 tion, or, better, after exposure of the regional nerves, is said to be 

 very efficient in preventing the development of tetanus. Calmette 

 has used dried tetanus antitoxin to dust the navel of the newborn in 

 the tropics and the deaths from tetanus neonatorum have been very 

 greatly reduced by this procedure. 3 Bockenheimer has made a dressing 

 composed of an ointment mixed with tetanus antitoxin, which is also 

 said to be very efficient not only for the treatment of the umbilicus 

 of the newborn, but for other wounds as well. 



Tetanus antitoxin is less efficient than the diphtheria antitoxin for 

 several reasons. First, the diphtheria antitoxin has a greater affinity 

 for its toxin in vitro than the tetanus antitoxin has for tetanus toxin. 

 Second, diphtheria toxin appears to infect principally the parenchy- 

 matous and lymphatic organs. The cells comprising these organs are 

 less susceptible to toxin than are nerve cells, which are energetically 

 attacked by tetanus toxin. The diphtheria toxin has less affinity for 

 parenchymatous cells than it has for its antitoxin, and the diphtheria 

 toxin, furthermore, circulates in the blood stream where the antitoxin 

 also circulates when it is injected. Treatment, therefore, with diph- 

 theria toxin is successful even after symptoms develop. Fourth, 

 tetanus toxin has a considerably greater affinity for nerve cells than 

 it has for its own antitoxin. The tetanus antitoxin is "picked up" 

 by the end-organs of the nerves and reaches the central nervous system 

 by the axis cylinders, while the antitoxin circulates in the blood and 

 is not carried to the central nervous system by way of the nerves. 

 Treatment with tetanus antitoxin, consequently, is rarely successful 

 after symptoms appear and practically never successful after the 

 symptoms have been developed for twenty-four hours. 



1 Bull. Johns Hopkins Hosp., July, 1895. 



2 Roux and Borrel, Ann. Inst. Past., 1898, No. 4. Chauffard and Quenu, La Presse 

 Med., 1898, No. 5. 



3 It must be remembered that the albuminous substances contained in the antitoxin, 

 mixed with serum from the wound, make a favorable culture medium for many bacteria; 

 the dressings must be sterile and watched carefully to safeguard the patient. 



