458 Tetanus 



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,* 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 strychnin does. The affinity 

 of the toxin for the nervous tissues has been made the 

 subject of careful investigations by Marie and Moraxf and 

 Meyer and Ransom. J The former found that the absorption 

 of tetanus toxin took place partly through the peripheral 

 nerves because of specific affinity between the toxin and 

 the axis cylinder substance; the latter found the toxin car- 

 ried to the central nervous system solely by the motor 

 nerves, the action depending upon the integrity of the 

 axis cylinder. They believe that the toxin is absorbed 

 by the axis cylinder endings, and reaching the correspond- 

 ing spinal nerve center by that route spreads to the cor- 

 responding center in the other half of the cord and out- 

 ward, resulting in generalized tetanus. When intoxication 

 is produced through the circulation, the poison is taken 

 up by the nerve endings in all parts of the body, and the 

 disease is not localized, but general. Antitoxin, unlike the 

 toxin, does not travel by the nerve route, but is found only 

 in the blood and lymph. 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 



* "Therapeutic Gazette," March 15, 1897. 



t "Ann. de 1'Inst. Pasteur," 1902, xvi, p. 818; and "Bull, de 1'Inst. 

 Past.," 1903, i, p. 41. 



J "Archiv. f. exper. Path. u. Pharmak.," 1903, XLIX. 

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



