TETANUS 49 



diphtheria bacilli is difficult, unless recourse is had to animal experi- 

 ments, but as a rule they produce no acid, or only produce it slowly, 

 and in small quantity, in glucose broth, and show no, or but few, 

 polar bodies. 



TETANUS 



The pathology of tetanus is very much like that of diph- 

 theria. In each disease the specific bacilli are localized at 

 or near the region at which they enter the body, and form a 

 toxin which affects distant organs. In the case of diphtheria, 

 as we have seen, the toxin passes by the blood-stream, but in 

 tetanus it creeps from the region where it is produced up the 

 peripheral nerves to the brain and spinal cord. In each case 

 research has shown that an antitoxin is formed which 

 neutralizes this toxin and prevents it from uniting with the 

 cells of the body, but which has not the power of turning it 

 out from such a combination. In other words, tetanus anti- 

 toxin, like that of diphtheria, is preventive, but not curative. 

 But here, unfortunately, the resemblance between the two 

 diseases ceases. The local lesion in diphtheria is obvious, and 

 its presence causes a good deal of inconvenience to the patient ; 

 he sees a medical man early, and the diagnosis of diphtheria is 

 made before much of the toxin has entered the blood. It is 

 different with tetanus. In this the local symptoms are prac- 

 tically nil; there may be suppuration at the region of inocula- 

 tion, but this is so common as not to excite suspicion. The 

 result is that the diagnosis is not made until the appearance 

 of the symptoms referable to the nervous system indicates 

 that the period at which antitoxin might have been used with 

 success has gone by. 



To illustrate this we will imagine the local lesion of diph- 

 theria to be so slight as to be unnoticed by doctor and patient. 

 The result would be that the disease would only be diagnosed 

 when the severe toxaemic symptoms had manifested them- 

 selves, and antitoxin would then be almost or quite useless. 

 If it were not for the discomfort and pain caused by the 

 throat lesion of diphtheria, the antitoxin treatment of the 

 disease would have probably been abandoned as useless. 



But tetanus may be diagnosed by means of a bacteriological 

 examination of the local lesion before toxic symptoms have 

 appeared, and in cases where this is done we may safely look 



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