BOTULISM OR ALLANTIASIS 521 
incubated for forty-eiji;ht lioiirs and examined niieroscopically for 
typical spores. If these are fonnd the material is heated to 80° ('. for 
thirty minutes to kill vegetative forms and then reinoculated to obtain 
growths of the organism. 
3. 7'o.ri«.— Inoculation of material containing tetanus bacilli and 
other organisms into slightly alkaline broth (sugar-free) grown anaero- 
bically for six to eight days will lead to toxin formation even if other 
bacteria are present. Inoculation of this toxic broth into mice will 
frequently give positive results. Broth obtained according to the 
Theobald Smith method in Step 2 also should be inoculated into mice 
if the preliminary microscopic examination shows tetanus spores. 
4. At times tetanus toxin occurs even in the blood of the patient, 
provided no antitoxin has been administered; 1 cc. of this blood inocu- 
lated into a mouse may occasionally produce characteristic tetanic 
phenomena. 
Prophylaxis.— Any wound likely to be a suitable portal of entry for 
the tetanus bacillus should be regarded as potentially dangerous and 
tetanus antitoxin should be administered promptly as a prophylactic 
measure. Fifteen hundred units of tetanus antitoxin is the ordinary 
prophylactic dose in such cases. For curative doses 3000 to 20,000 
units have been injected locally, intraneurally or subdurally, depending 
upon the condition of the patient and the time which has elapsed since 
infection took place. The results are usually unsatisfactory if symp- 
toms of tetanus have developed, but the treatment should be carried 
out energetically. 
BOTULISM OR ALLANTIASIS. 
A rather definite train of symptoms consisting of gastro-intestinal 
irritation, nervous disturbances, bulbar paralysis, dysplagia and pro- 
trusion of the eyeballs with, however, no fever, has occasionally fol- 
lowed the consumption of uncooked or imperfectly cooked meats. 
Vegetables, fish, smoked hams or sausages, pickled pork products, as 
well as vegetables and olives,^ which have been imperfectly preserved, 
are more commonly the source of these intoxications. The mortality 
is fairly high in such cases although the death-rate has varied from 
10 to 90 per cent in the various epidemics which have been reported. 
Patients who succumb to botulism retain their consciousness to the 
end as a rule, and the heart may continue to function several minutes 
after respiration ceases. 
The first epidemic of this kind was one which occurred in Ellezelles, 
Belgium, ^'on Ermengem^ investigated this epidemic very thoroughly 
and found that all the cases had partaken of an imperfectly cured ham, 
from which he isolated an organism which he called B. botulinus. He 
established the relationship of the organism to the disease which 
' Jour. Am. Med. Assn., 1920, 74, 530, 1220. 
2 Centralbl. f. Bakteriol., 1896, 19, 442; Ztschr. f. Hyg., 1897, 26, 1. 
