358 Tetanus 



13 lethal doses symptoms in 36 hours 



no lethal doses symptoms in 24 hours 



333 lethal doses symptoms in 20 hours 



1300 lethal doses > symptoms in 14 hours 



3600 lethal doses symptoms in 12 hours 



The local action of the toxin is very painful and associated with 

 spasm of the muscular fibers with which it comes in contact. Pit- 

 field,* thinking that it might be useful in the treatment of certaia 

 paralytic affections, injected a minute quantity of it into the calf 

 of his leg and experienced the severe spasmodic local effects of the 

 poison for twelve hours. 



It has been the belief of most physiologists that tetanus toxin 

 acts solely upon the motor cells of the spinal cord, and causes the 

 tonic spasms as strychnin does. The affinity of the toxin for the 

 nervous tissues has been made the subject of careful investigations by 

 Marie and Moraxf and Meyer and Ransom. J The former found 

 that the absorption of tetanus toxin took place partly through the 

 peripheral nerves because of specific affinity between the toxin and 

 the axis cylinder substance; the latter found the toxin carried to the 

 central nervous system solely by the motor nerves, the action de- 

 pending upon the integrity of the axis cylinder. They believe that 

 the toxin is absorbed by the axis cylinder endings, and reaching the 

 corresponding spinal nerve center by that route spreads to the corre- 

 sponding center in the other half of the cord and outward, resulting 

 in generalized tetanus. When intoxication is produced through the 

 circulation, the poison is taken up by the nerve endings in all parts 

 of the body, and the disease is not locaUzed, but general. Antitoxin, 

 unlike the toxin, does not travel by the nerve route, but is found only 

 in the blood and lymph. Zupnik§ has brought forward evidence 

 that this view is incorrect and that there are two distinct actions 

 caused by the toxin. He differentiates between tetanus ascendens 

 and tetanus descendens. The former always follows the intramus- 

 cular introduction of the toxin, and depends upon its direct action 

 upon the muscle itself. It explains the familiar phenomenon of 

 rigidity making its first appearance in that member into which the 

 inoculation was made. The ascending tetanus gradually ascends 

 from muscle to muscle. He thinks the absorption of the poison by 

 the muscle-cells depends upon their normal metabolic function, as 

 when their nerves are severed, the fixation of the toxin and the 

 occurrence of the tonic spasm does not occur. 



Tetanus descendens results from the entrance of the toxin into the 

 circulation from the cellular tissue and its distribution in the blood. 

 Under these conditions Zupnik believes it acts upon the central 



* "Therapeutic Gazette," March 15, 1897. 



t "Ann de I'lnst. Pasteur," 1902, xvi, p. 818; and "Bull, de I'Inst. Past.," 

 1903, I, p. 41. 



X "Arch. f. exper. Path. u. Pharmak.," 103, xldc. 

 § "Wiener klin. Wochenschritt," Jan. 23, 1902. 



