Antitoxin of Tetanus 349 



intestine and be absorbed, especially where imperfections in the 

 mucosa exist. 



Montesano and Montesson,* unexpectedly found the tetanus 

 bacillus in pure culture in the cerebro-spinal fluid of a case of para- 

 lytic 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 castration, accouchement, 

 or abortion. Most birds are scarcely at all susceptible either to the 

 bacilli or to their toxin. Amphibians and reptiles are immune, 

 though it is said that frogs can be made susceptible by elevation of 

 their body-temperature. 



The injection of the toxic bouillon or of the redissolved ammonium 

 sulphate precipitate, in progressively increasing doses, into animals, 

 causes the formation of antibodies (antitoxin) by which the effects of 

 both the tetanospasmin and the tetanolysin are destroyed. The 

 purely toxic character of the disease makes it peculiarly well adapted 

 for treatment with antitoxin, and at the present time our sole 

 therapeutic reliance is placed upon it. The mode of preparing the 

 serum and the system of standardization are discussed in the section 

 upon Antitoxins in the part of this work that treats of the Special 

 Phenomena of Infection and Immunity. 



Antitoxin. — Numerous cases of the beneficial action of antitoxin 

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

 tetanus is a disappointment in the treatment of tetanus. Moschco- 

 witz,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. 



Irons § has analyzed 225 cases of tetanus treated with antitoxic 

 serum and found the mortality 20 per cent, lower than in cases 

 otherwise treated. He says that it is important that the full effect 

 of the antitoxin be immediately obtained, the best method of using 

 it being that outlined by Park in which 3000 units are given intra- 

 spinously at the earliest possible moment after the symptoms ap- 

 pear, and 10,000 to 20,000 units given intravenously at the same 

 time. On the following day the intraspinous injection of 3000 

 should be repeated. On the fourth or fifth day, 10,000 units should 

 be given subcutaneously. By these means a high antitoxic content 

 of the blood and juices is maintained. 



The use of antitoxic serums must not replace other non-specific 

 modes of treatment such as local treatment of the wound and the 

 administration of sedatives, etc. The result of its experimental in- 

 jection, in combination with the toxin, into mice, guinea-pigs, rab- 

 bits, and other animals is perfectly satisfactory, and affords protec- 



* "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. 

 I Annals of Surgery," 1900, xxxii, 2, pp. 219, 416, 567. 

 S Jour. Am. Med. Asso.," 1914, lxii, 2025. 



