TETANUS 229 



whore 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 

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

 Quite suggestive also are the results which have been obtained 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 which 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 



