TETANUS 245 



attempt has accordingly been made to bring the material into imme- 

 diate contact with the central nervous structures, by intraneural 

 injections, through intracerebral injections and by its introduction 

 into the subarachnoid space. The intracerebral method is to be 

 deprecated altogether, as the death rate following its use has been 

 exceedingly high. More appropriate is the intraneural route, to 

 which end the larger nerve trunks, along which absorption has likely 

 taken place, must be exposed and injected at different points in 

 their course. Unfortunately, not much serum can be introduced in 

 this manner, and it is natural that the patient should subsequently 

 suffer a good deal from the resulting neuritis. By the subdural 

 route, on the other hand, it is easy to introduce large quantities of 

 serum, and as Stintzing and Ku'ster have already demonstrated 

 that the cerebrospinal fluid usually contains a considerable amount 

 of toxin in human tetanus, this method of treatment seems rational 

 and likely to do good so long as recovery is at all possible, i. e., so 

 long as the union between toxin and the sensitive receptors is still 

 capable of being broken. It is recommended to tap the subarach- 

 noid space in the usual manner, to allow as much of the meningeal 

 fluid to escape as possible, care being taken, however, not to let the 

 pressure fall too low, and then to slowly inject an equivalent volume 

 of serum (10 to 20 c.c.) at a rate of about 2 c.c. per minute. According 

 to the requirements of the case, this may be repeated several times 

 within the same twenty-four hours, and continued on the following 

 days. 



As antitoxin treatment in tetanus can be expected to do good 

 only so long as the toxin has not combined with the sensitive recep- 

 tors of the central nervous system (barring those exceptional cases 

 where this union can still be broken), and so long as it can be readily 

 reached by the antitoxin, i. e., before it has begun its travel along 

 the axis-cylinders of the affected nerves, it follows that its use must 

 be largely limited to prophylactic purpose. As the treatment, how- 

 ever, is of signal value, when employed to this end, the practitioner 

 should resort to its use in all those injuries which are likely to favor 

 infection with tetanus bacilli. It is hence recommended in connec- 

 tion with all wounds which have been contaminated with earth, 

 manure, decomposing vegetable matter of any kind, particles of 

 clothing, especially in puncture wounds, such as those produced 

 by splinters of wood, rusty nails, and broken crockery; then in con- 



