462 Tetanus 



that the bacilli can grow in the intestine and be absorbed, 

 especially where imperfections in the mucosa exist. It is 

 not impossible, though he does not think it probable, that 

 the bacteria growing in the intestine can elaborate enough 

 toxin to produce the disease by absorption. 



A peculiar observation has been made by Montesano and 

 Montesson, * who unexpectedly found the tetanus bacillus 

 in pure culture in the cerebro-spinal fluid of a case of par- 

 alytic dementia that died without a tetanic symptom. 



Immunity. All animals are not alike susceptible to 

 tetanus. Men, horses, mice, rabbits, and guinea-pigs are 

 susceptible; dogs much less so. Cattle suffer chiefly after 

 accouchement, and after abortion. Most birds are scarcely at 

 all susceptible either to the bacilli or to their toxin. Am- 

 phibians and reptiles are immune, though it is said that frogs 

 can be made susceptible by elevation of their body-tempera- 

 ture. 



Antitoxin. Numerous cases of the beneficial action of 

 antitoxin are on record, but, as Welchf has pointed out, 

 the antitoxin of tetanus has proved a disappointment in 

 the treatment of tetanus. Moschcowitz,J in his excellent 

 literary review of the subject, has shown that its use has 

 reduced the death-rate from about 80 to 40 per cent., and 

 that it therefore cannot be looked upon as a failure. The 

 result of its experimental injection, in combination with 

 the toxin, into mice, guinea-pigs, rabbits, and other animals 

 is perfectly satisfactory, and affords protection against 

 almost any multiple of the fatal dose, but the quantity 

 needed, in proportion to the body-weight, to save an animal 

 from the unknown quantity of toxin being manufactured 

 in its body increases so enormously with the day or hour 

 of the disease as to make the dose, which increases millions 

 of times where that of diphtheria antitoxin increases but 

 tenfold, a matter of difficulty and uncertainty. Nocard 

 also called attention to the fact that the existence of tetanus 

 cannot be known until a sufficient toxemia to produce 

 spasms exists, and that therefore it is impossible to attack 

 the disease in its inception or to begin the treatment until too 



* "Centralbl. f. Bakt. u. Parasitenk.," Dec., 1897; Bd. xxn, Nos. 



22, 23, p. 663. 



t" Bulletin of the Johns Hopkins Hospital," July and August, 

 1895. 



t "Annals of Surgery," 1900, xxxn, 2, pp. 219, 416, and 567. 



