The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
The tetanus bacillus manifests other peculiar properties, for some of
which it is most difficult to account. Upon susceptible animals it is
violently infectious, but is rarely found at any distance from the
tissues in which it has first lodged. In laboratory investigations the
period of incubation is seldom longer than forty-eight hours. Another
peculiarity of the organism is that it generates certain poisons of
active properties which may be separated from pure cultures, by whose
injection the peculiar spasms of the disease itself may be reproduced.
These have been isolated, especially by Brieger, who has given to them
the names of _tetanin_, _tetanotoxin_, _spasmotoxin_, etc. It has been
estimated that about ¹⁄₃₀₀ Gm. of the pure toxin of tetanus would be a
fatal dose for a man. This toxin seems to have a specific affinity for
the ganglion cells of the anterior horn of the spinal cord, with which
it unites with great force. Herein lies the secret of its disturbing
power.
It is peculiar that some time may elapse after its injection before the
appearance of the first symptoms. Diphtheria toxins appear to be prompt
in their action, and thus display quite opposite characteristics.
Experiment would seem to show, moreover, that the tetanus toxins do not
reach the cord through the blood stream, but appear to slowly pass
along the axis cylinders. Sensory nerves do not transport the toxins
to the cord. The toxin enters the nerve termination, first of all, at
the site of the infection, where it is most concentrated, which will
explain why the spasms most frequently begin in the vicinity of the
infection, or are the most marked there. Most of the toxin is taken
up by the blood and lymph and distributed all over the body, and
then passing along the motor fibers it enters the cord and leads to
general convulsion. When the toxin is injected directly into the cord
the symptoms begin at once. Therefore, for protective purposes, much
may be expected from the administration of the antitoxin in cases of
suspicious injury or those where experiment has shown there is reason
to fear the development of tetanus. There does not appear to be on
record a single instance in which a person who had been given antitoxin
soon after receiving such a wound has developed tetanus, nor does the
antitoxin by itself seem to have done any harm. Obviously, then, the
earlier antitoxin is used in the case the better. It may be recalled
that there are no diagnostic symptoms of tetanus until the first spasm
develops, usually after the expiration of from five to twelve days. By
this time the nerve cells are thoroughly saturated with the poison and
considerable time may elapse before the antitoxin can reach these cells
by a more indirect route.
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