TETANUS. 55 
TETANUS. 
The pathology of tetanus is very much like that of 
diphtheria. In each disease the specific bacilli are 
localised at or near the region at which they enter the 
body, and form a toxin which is absorbed into the 
blood and affects distant organs. In each case research 
has shown that an antitoxin is formed which neutralizes 
this toxin and prevents it from uniting with the cells of 
the body, but which has not the power of turning it out 
from such a combination. In other words tetanus 
antitoxin, like that of diphtheria, is preventive but not 
curative. But here, unfortunately, the resemblance 
between the two diseases ceases. The local lesion in 
diphtheria is obvious and its presence causes a good 
deal of inconvenience to the patient; he sees a medical 
man early, and the diagnosis of diphtheria is made 
before much of the toxin has entered the blood. It 
is different with tetanus. In this the local symptoms 
are practically nil; there may be suppuration at the 
region of inoculation but this is so common as not to 
excite suspicions. The result is that the diagnosis is 
not made until the appearance of the symptoms refer- 
able to the nervous system indicates that the period at 
which antitoxin might have been used with success has 
gone by. 
To illustrate this we will imagine that the local lesion 
of diphtheria to be so slight as to be unnoticed by 
doctor and patient. The result would be that the 
disease would only be diagnosed when the severe 
toxemic symptoms had manifested themselves, and 
antitoxin would then be almost or quite useless. If it 
