The St. Louis Republic. [volume] (St. Louis, Mo.) 1888-1919, 1901-11-19

tion Of petechial hemorrhages. could he observed.
In no instance was there any evidence Of infiari-
search for wounds revealed nothing but the sites
of the injections. which, however. sometimes
could only be detected with difficulty, or not
all.
At each autopsy pieces OF the different organs
excepting the Ernst easel were removed for
microscopic examination. and in every case pieces
OF the mispheres. basal ganglia. pons, Idedulla
and cervical cord were transferred Immediately
into alcohol or into 10 per cent formal. The mi
croscopic examination has not revealed anything
more than the microscopic inspection. with the
exception Of two cases mentioned above. where
the macroscopically detected LESSONS due to other
diseases were simply confirmed by the micro
scope: no anomalies but very general and pro-
nounced hyperaemia OF the organs were found
In one case the area of skin surrounding the
site of injection was removed and examined mi
croscopically and bacteriologically; the micro
scope showed only intense hyperaemia OF all the
vessels Of the skin. subcutaneOus tissue and ab-
dominal muscles, while the aerobic and anaerotlc
tubes inoculated with material from this specl-
mon remained sterile Il must be mentioned.
however that the attending physician in this case
had injected into the same place before death
solution Of bchloride OF mercury.
The interest Of the microscopic examination
certAra. in the material taken from the cord
and nedulla. Numerous sections were made from
the material Of every case. and mainly stained
after the Nissl method. SoIne were prepared ac-
coidlng to The Weigert formula, but In the lat
ter no changes could be seen. The Nissl speci-
mems showed in all Of the sections the same con-
clifton in about the same degree OF intensity.
Numerous gangliOn cells. and especially the large
notor cells of the anterior horns. exhibited a
beautiful picture OF the so-called chromatolysis.
sv cling OF the nucleolus, obliteration or the
processes, etc 1t seemed. however. that the
charges did not have that degree OF intensity
that is the outcC me of incubation experiments
in aninals or in the ordinary case OF human
,raumatic tetanus. Besides the pathological nerve
cells a great number Of normal cells were found.
raFp fbarry
fectly to those published by Barker. The Nerv-
Gus Sy STEM. pages soi-3O5 1t is to be noted here
Il at the changes described could not have been
post-mortem alterations. because some Of the
sutorses were made too scon after death for
sucE char ges to have occurred.
II the whole of this is considered. II Is seen
that in all Of the post-mortems made nothing was
discovered that could justify the assumption that
the death OF these patients due to some
other patholoEic process. Even in Jacob Gen.
turio. and in Mamie Keenan, the scariatina and
rpon necessarily fatal. On the other hand.
these Investigations do not give any direct and
ircortrovertible evidence that the cause Of the
deaths was tetanus although the clinical evi-
dcnce alone was Certainly sufficient to reraoye
any doubt
To furnish this direct proof. attempt to
produce in animals the disease. by means Of in
cooperating into them material removed from the
patients during life and after death. From the
beginning the prognosis for a favorable result was
bad. for two reasons. The human organism be-
longs TO that category of animal beings which
absorbs with great rapidity the tetanus toxin
produced at the focus Of infection artifcally
introduced. In a short time after a given guam
tity Of such toxin is in any way introduced Ii Is
completely confined to the susceptible cells. and IL
is the general experience that at the height of
the tetanc process no free toxin is found in the
human body. The second reason was that most
Of the patients had received copious admnistra-
tions OF tetanus antitoxin before DEATH so that.
whatever quantity of the toxin was present in
the fluids Of the body OF the patient. it must
have been neutTalized and made inaccessible to
the demonstration by this antitoxin.
That, in fact, a surplus of antitoxin was present
was demonstrated in the case Of Ike Stein. from
whom during life some cerebro-spinal fluid and
blood were removed for therapeutic purposes. We
injected some OF this cerebro-spinal fiuid, mixed
with a fatal dose OF the tetanus toxin, into a
mouse, and found that the animal remained per
fectly well. while another mouse injected only
with the fatal dose of the toxic serum died
within three days with typical symptoms OF tet-
anus. Thus IL was demonstrated that the pa
tlent died Of etanus in spite Of the fact that his
blood contained large amount Of tetanus anti
toxin.
jected with large amounts Of this material
was compatible with their size and weight. The
appended table 80 gives the details Of these
experiments. In case have We obtained a posi-
tive result Some Of animals died Of sec
ondary Infection or rather from infections with
organisms introduced together with the pathO-
logic material as cultures made from the lat-
ter showed. in some cases. the presence Of
saphrophytic bacteria having invaded IL after
death
Special attention may be called here TO the ex-
periments in which the site Of injection was eS-
posed and triturated. See table s. Here. too. 10
tetanus developed. 1t must. however. be men,