324 SURGERY 



the mortality half, and if the antitoxin were properly used, the mor- 

 tality would be much less than half. The reasons why antitoxin 

 has no better statistics at the present time are because the anti- 

 toxin has not been pure or long enough continued, or not in suffi- 

 cient doses, or too late in its administration. If properly used, the 

 reduction in mortality would be striking, and from now on the 

 results will be entirely different. Antitoxin has its widest field of 

 usefulness as an immunizing agent. All surgeons agree that it 

 would not be justifiable to immunize a patient on the vague sup- 

 position that tetanus might develop. The use of the antitoxin as 

 a prophylactic measure is consequently limited to those cases where 

 the wound has been inflicted in such a manner as to allow garden- 

 earth, plaster from walls, or manured soil to come in contact with 

 it, or where the traumatism has been caused by a rusty nail upon 

 which the bacilli are discovered, or in a given locality where tetanus 

 is prevalent, or where the wound is a lacerated one with entrance 

 of foreign bodies into it. In these cases Murphy states that the 

 injection of antitoxin has reduced the mortality 50 %. 



Bazy, a French surgeon, had four fatal cases of tetanus in his 

 practice in one year, and subsequently began injecting 20 cc. of 

 serum into all patients who suffered from lacerated wounds, into 

 which extraneous matter had of necessity entered. Since he adopted 

 this practice, tetanus has not followed in those cases in which a 

 strong probability existed that this dreaded disease might develop. 

 Lambert mentions that Nocard, in veterinary surgery, immun- 

 ized 375 animals, and in no single case did tetanus develop, while 

 he had 55 cases of the disease in non-immunized animals in the 

 same environment. Antitoxin does not affect in any way the life 

 of the bacilli of tetanus, or the spores. Both the bacilli and their 

 spores, when they penetrate the tissues by a wound, live for days 

 and weeks. In these cases, when antitoxin is given for the purpose 

 of preventing the symptoms which would be caused by the toxins 

 during the first few days, it will destroy the action of the toxins. 

 If, however, some of the spores remain quiescent, they may only 

 develop into bacilli at a time when the antitoxin has been elimin- 

 ated, and if they then develop into bacilli the toxins produced 

 will be absorbed, and cause symptoms just as if they had received 

 no immunization dose of antitoxin. For this reason, the immun- 

 izing dose should be repeated after the first week, and even after 

 the third week. 



Antitoxin as a remedy during the progress of the disease has 

 an important influence upon tetanus; but not to the same extent 

 as when employed for immunizing purposes. Welch believes that 

 the longer the period of incubation, the better will be the results 

 from the use of antitoxin, and that this remedy is of little value 



