Antitoxin of Tetanus 361 



the surrounding conditions rarely enable it to develop satisfactorily 

 and produce enough toxin to cause disease. 



In very rare cases tetanus may possibly occur without the pre- 

 vious existence of a wound, as in the case reported by Kamen,* who 

 found the intestine of a person dead of the disease rich in Bacillus tetani. 

 Kamen is of the opinion that the bacilh can grow in the intestine 

 and be absorbed, especially where imperfections in the imucosa exist. 



Montesano and Montesson,t 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. — ^AU 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 aU 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. — WelchJ early pointed out that the antitoxin of tetanus 

 is a disappointment in the treatment of the disease. Moschowitz,§ 

 in an excellent review of the subject, came to the conclusion 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. 



Ironsll analyzed 225 cases of tetanus treated with antitoxic serum 

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

 treated. On the other hand, Gessner,** in an analysis of cases 

 treated m the Charity Hospital of Louisiana, located in New Orleans, 

 found that the percentage of deaths from tetanus in the decade from 

 1840-1849 was 68.7, and that in the decade from 1900-1909 was 

 68.7 and that for the year 1910-1917, 68.5. A comparison of all 

 the cases in the years 1 840-1 889, the pre-antitoxin period, with those 

 in the years 1890-19 17, shows the former group to have a death- 

 rate of 79.1 per cent., the latter 70.7 per cent., a gain of 8.4 per cent. 



*"Centralbl. f. Bakt u. Parasitenk.," 1895, xviii, p. 513- 

 t " 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. 

 § "Annals of Surgery," 1900, xxxn, 2, pp. 219, 416, 567. 

 II "Jour. Am. Med. Assc," 1914, ixn, 2025. 

 ** 'Jour. Am. Med. Asso.," Sept. 14, 1918, lxxi, No. ii, p. 867. 



