66 BACTERIAL POISONS OF INFECTIOUS DISEASES. 



By separating the blood corpuscles, which have been exposed to 

 the action of varying quantities of tetanolysin for different periods 

 of time, in a centrifuge, and subsequently treating them with tetanus 

 antitoxin, Madsen ^ has shown that the poison can be separated from 

 the corpuscles provided a sufficient quantity of antitoxin is added 

 before hemolysis occurs. In this way he has demonstrated that the 

 antitoxin may act as a curative agent, as well as a preventive. 



Ransom ^ has shown that both the toxin and antitoxin of tetanus 

 pass without change from the blood into the lymph. Shortly after 

 the intravenous injection of the toxin it is found equally distributed 

 between the blood and the lymph, while the antitoxin remains in 

 comparative excess in the blood. From these observations it is con- 

 cluded that the toxin behaves like inorganic substances in passing 

 from the blood into the lymph, while the antitoxin resembles more 

 closely the proteids in this respect. 



Bruschettini has studied the distribution of the tetanus poison in 

 the body and its elimination ; animals poisoned by injections of the 

 toxin were killed just before death, and bits of various organs rubbed 

 up with sterilized water were injected into other animals. Emul- 

 sions from the liver and suprarenal capsule were invariably without 

 effect, while those from the kidney were constantly poisonous. The 

 blood taken from the vena cava was found to be poisonous in three 

 out of four experiments. When injections were made under the skin 

 the lumbar cord was active in four out of eight cases, and in all 

 when the injections were made directly into the sciatic nerve. When 

 the inoculations were made under the dura mater, the brain was 

 found to be active, while the lumbar cord remained inactive ; it fol- 

 lows from this that the toxin not only circulates in the blood, but is 

 deposited in the central nervous system. This author has also shown 

 that tetanus toxin is eliminated by the kidneys. Bruner in several 

 cases of tetanus in man. Stem in two, and Brieger in one case, were 

 not able to induce tetanus in animals by injecting even large amounts 

 of the urine of their patients. This does not cast doubt upon the 

 accuracy of the report of Bruschettini ; it only shows that the poison 

 is not in all cases eliminated by the kidney in sufficient quantity 

 to render the urine highly toxic. In a fatal case, Vulpius failed to 

 induce tetanus with the urine voided during life, but succeeded with 

 that found in the bladder after death. 



Donitz' has shown that tetanus toxin combines almost instan- 

 taneously with the cells of the central nervous system. In his ex- 

 periments he employed twelve times the minimum lethal dose of toxin, 

 and injected this directly into a vein of the ear. He first determined 

 the amount of antitoxin which, mixed with this quantity of toxin in 



^ Zeitsahrift fihr Eyffiene, 32, 239. 



' Zeiisehnft fiir phyaiol. Chem., 29, 1900. 



' Deutsche med. Woehevschrift, 1897, 428. 



