DEVELOPMENT IN NINETEENTH CENTURY 325 



with a short incubation period, that is, less than seven days. When 

 antitoxin is used under these circumstances, it should be continued 

 long after the symptoms of tetanus have subsided. Lambert has 

 also called attention to a most important point in the treatment 

 of tetanus, and that is, the great care the surgeon should exercise 

 after all symptoms have disappeared. For example, absolute quiet 

 should be insisted upon long after the patient has become con- 

 valescent, since he knows of five deaths recently in New York City 

 where the patients were awakened suddenly out of a sound sleep, 

 and a convulsion was brought on from which the patients died. 



Antiseptic surgery plays an important r61e in the treatment 

 of tetanus, since it has been shown that in the majority of cases 

 of tetanus the infection proceeds from the development of the 

 spores rather than from the bacilli. It has also been demonstrated 

 that the spores develop better under special circumstances of a 

 mixed infection, and, therefore, all tetanus wounds should be made 

 aseptic in order to destroy the microbes of suppuration, notably 

 the streptococci and the staphylococci. It often happens that the 

 wound is situated on an extremity, notably on the finger or toe, 

 and the question arises as to the propriety of amputation of the 

 affected part. This operation is of no avail unless the sacrifice is 

 made immediately after the infliction of the injury, but it is indi- 

 cated if the .wound cannot be thoroughly disinfected. It is better 

 to live without a finger or toe, or even a leg, than to run the risk 

 of tetanus with its attendant suffering, which leads in the acute 

 cases so often to death. The small punctured wounds, which may 

 seem insignificant, should be incised deeply, thoroughly cleansed, 

 and then properly drained. The toxins of tetanus are chiefly elim- 

 inated by diuresis. To best utilize this channel of elimination the 

 imbibition of large quantities of fluid is indicated. The saliva has 

 also been said to be a channel of elimination. . The function of the 

 skin has not been proved to be of any avail in eliminating the poi- 

 son. The employment of anodynes forms also a prominent part 

 of the treatment. This step, therefore, should not be overlooked, 

 since it is clearly proved that much suffering can be relieved by 

 certain drugs. Among the drugs that are found to be most useful 

 are chloroform, morphine, chloral, bromides, physostigmin, anti- 

 mony, and nitrate of amyl. Chloroform is a most valuable remedy, 

 because it relieves the intense suffering and diminishes the inten- 

 sity of the spasm and also prevents suffocation. This agent must 

 be used with every precaution and with every stimulant present, 

 and ready for immediate use. Statistics show that when chloro- 

 form was employed in the treatment of tetanus, the mortality was 

 10 per cent less than in the cases when the drug was not employed. 



