228 PASSIVE IMMUNIZATION 



largely limited to prophylactic purposes. As the treatment, however, 

 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 con- 

 nection 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- 

 nection with all wounds caused by exploding firearms, 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. 



When once tetanus symptoms have developed, very little can be 

 expected. If the attempt is to be made, however, it should not be 

 delayed unnecessarily, and the subdural route chosen by preference. 

 When large nerve trunks have been exposed, intraneural injections 

 should be given in addition, besides which subcutaneous injections 

 also may be employed. Intravenous injections, as I have already 

 pointed out, can hardly do any good. 



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

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

 cally 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 anni- 

 versary 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 appalling. 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 convin- 

 cing are the reports from certain hospitals, in which antitetanus 

 injections are given as a matter of routine in all cases where contami- 

 nation of wounds with dirt from the street has occurred, and where 

 the disease is under these conditions hardly ever seen again. 



While tetanus is a fairly common malady in the province of 

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



