246 PASSIVE IMMUNIZATION 



nection with all wounds caused by exploding fire-arms, cartridges, 

 fire-crackers, rockets; in wounds caused by unclean instruments, as 

 on battle fields, after division of the umbilical cord, removal of the 

 placenta, etc. In all such cases the use of tetanus antitoxin is strongly 

 to be advocated, and should become a uniform practice. 



Ashhurst and John have recently advocated simultaneous intra- 

 neural injection, intraspinal injection, intravenous injection, and 

 the infiltration of the tissues about the site of the injury, and empha- 

 size the use of much larger amounts of antitoxin than have hitherto 

 been employed. They report a mortality of only 36.36 per cent., 

 and express the opinion that with the treatment indicated, if com- 

 menced within twelve hours of the appearance of the first symptoms, 

 the mortality should not be over 20 per cent. 



Results. If now we turn to an analysis of the results which the 

 introduction of the antitoxin treatment has produced, we may prac- 

 tically confine our attention to the prophylactic side of the question. 

 The evidence here is quite conclusive that its timely use may be 

 the means of saving many lives. In our own country, where the 

 anniversary of the birth of the nation's independence has in the 

 past been annually celebrated by a tetanus orgy, the death rate in 

 the absence of prophylactic treatment has been perfectly apalling. 

 Liell, in an analysis of 350 cases, thus reports that of this number 

 only seven recovered (mortality 98 per cent.), of which five had 

 received the prophylactic treatment. Scherk then mentions that of 

 591 cases of Fourth-of-July injuries which received prophylactic 

 injections of antitoxin, not a single one developed the disease. 

 Equally convincing are the reports from certain hospitals, in which 

 antitetanus injections are given as a matter of routine in all cases 

 where contamination of wounds with dirt from the street has occurred 

 and where the disease is under these conditions hardly ever seen. 



While tetanus is a fairly common malady in the province of 

 Pommern it has thus been noted at the surgical clinic of Greifswald, 

 where the prophylactic treatment of all primary injuries has been 

 carried out for a number of years, that tetanus among the injected 

 is practically unheard of, while it is common enough among patients 

 that are sent in from the surrounding districts where this treatment 

 is not in use. In Indo-China further, where formerly one-fifth of all 

 newborn children succumbed to tetanus of umbilical origin, Calmette 

 found that the administration of the dried preparation to the stump 



