BACILLACE^: THE SPOROGENIC ANAEROBES 295 



Tetanus antitoxin seems to be a reliable preventive of teta- 

 nus if given soon after the wound is inflicted in a dose of 20 anti- 

 toxic units (German) or 1500 immunity units (U. S. Standard). 

 After symptoms of tetanus have appeared, antitoxin is of less 

 use. At this time the poison is present not only in the vicinity 

 of the wound and in the blood but also in the peripheral nerves 

 and in the central nervous system. The toxin in the last two situ- 

 ations is only slightly or not at all influenced by subcutaneous in- 

 jection of antitoxin. That in the peripheral nerves may be 

 reached by intraneural injection, and in subacute or chronic cases 

 recovery may sometimes take place. Acute cases in which symp- 

 toms appear in a few days after infliction of the wound offer no 

 hope. Prophylactic use of tetanus antitoxin in all punctured and 

 lacerated wounds, especially those caused by gunpowder (Fourth 

 of July) is an essential feature of the effective treatment for tet- 

 anus. Surgical cleansing and antiseptic open treatment of such 

 wounds is to be recommended.^ 



Late tetanus may appear even after the antitoxin has been 

 given early, but in such cases the disease is usually milder in char- 

 acter and may be successfully treated by further antitoxin and 

 surgical attention to the wound. 



Clostridium Botulinum. — Van Ermengem. in 1895 discovered 

 the spores of this organism in the interm.uscular connective tissue 

 of a ham which had given rise to 30 cases of food poisoning with 

 3 deaths. Other anaerobic as well as aerobic bacteria were also 

 present in the meat. Its natural habitat is unknown but it seems 

 to occur in the feces of swine. The bacillus 0.9 to 1.2/i wide 

 by 4 to 6/1 long and occurs single or in pairs. It is slightly motile 

 and has 4 to 8 peritrichous flagella. It is Gram-positive. The 

 spores are oval and usually nearer one end of the cell. They are 

 quite variable in resistance. Van Ermengem found that they were 

 killed at 80° C. in 30 minutes and by boiling for 5 minutes. More 

 recent careful tests by Burke^ have shown that the spores may 



1 Editoriai, Jour. A. M. A., 1909, Vol. LIII, p. 955. 

 ^ Burke, Journ. Amer. Med. Assn., 1919, 72, p. 88. 



