TETANUS 247 



of the umbilicus was sufficient to prevent the outbreak of the malady. 

 Quite suggestive also are the results which have been obtined in 

 veterinary practice. Nocard thus reports that in a certain quarter 

 of Paris where tetanus was exceedingly common among horses, not 

 a single case developed among 2727 injected animals concerning 

 which he received reports, and of which 2300 had been castrated; 

 while during the same period of time there occurred 259 cases among 

 those that had not been protected. 



Evidence of this sort is now so abundant that the importance, nay, 

 the necessity, of prophylactic treatment in the injured, where there 

 is the slightest reason for anticipating the possible development 

 of tetanus, cannot be too strongly urged. When a physician nowa- 

 days quietly dresses an extensive scalp wound of the head, which 

 has been freely contaminated with manure, and does not give his 

 patient the benefit of a prophylactic injection of tetanus antitoxin, 

 his negligence is certainly but little short of criminal. 



The question may, of course, be asked, whether tetanus never 

 develops if an early injection of antitoxin be given. While we must 

 admit that the protection is not absolute, the fact remains that if 

 tetanus does occur under such conditions its course is very mild. 

 Kiister thus mentions a case where infection occurred accidentally 

 in a laboratory with a highly virulent culture, and where, in spite 

 of prophylactic treatment, tetanus developed on the sixth day. In 

 such a case ordinarily death would unquestionably have followed, 

 but, as it was, the patient had an uncommonly mild attack which 

 resulted in recovery. 



Regarding the effect of the antitoxin treatment upon the malady 

 when once this has developed, very little need be said. If we rule 

 out from our consideration all those cases in w r hich the first symp- 

 toms have developed after nine days or still later, we may say that 

 death will result no matter whether the patient is injected or not. 

 In the case of the remainder, we must remember that the patient's 

 chances are the better the longer the period of incubation, so that 

 the conclusion is not necessarily warrantable that recovery has 

 taken place in such cases because of the injection. The best that 

 we can say is that the treatment may possibly help, but that we 

 cannot always logically attribute recovery to the treatment. It 

 should be tried, but not too much should be expected. 



