TETANUS. 503 



whatever treatment be adopted, the mortality is about 70 per cent. I 

 have made experiments as to the benefit of excising the inoculation 

 wound, and of injecting antitoxic serum. In our patient free removal 

 of the margins of the inoculation wound necessitates anaesthesia, with- 

 out which excessive excitement and violent struggling occur. It is of 

 less value than careful disinfection of the wound, provided this can be 

 done without causing pain. 



It is well known that the first antitoxic serums produced in Ger- 

 many and France were useless in the acute form of tetanus. They 

 have only proved successful in chronic tetanus, a form which in the 

 horse is often followed by recovery under the older forms of treatment. 



In November, 1896, Professor Dieckerhoff published in the Berliner 

 tliierdrztliche WocJienschrift some clinical cases which appeared to show 

 that a new antitoxin (Behring's dry antitoxin), manufactured in the 

 Sero-therapeutic Institute of Hochst-u.-Main, when subcutaneously 

 or intra-venously injected in doses of seventy-five grains, dissolved in 

 eleven and a quarter drachms of sterilised water, cured the acute form 

 of tetanus. In spite of the high price of the remedy (6s. 3^. per fifteen 

 grains), I procured a sufficient quantity to study the effects. Cases 

 156 and 157 were treated with an intra-venous injection of seventy-five 

 grains of this antitoxin. The first died twenty-four hours after injec- 

 tion, and the second on the fourth day. In three other horses affected 

 with acute tetanus, treated by subcutaneous injections of an emulsion 

 of nerve substance, and by intra-venous injections of iodine solution, 

 the course of the disease was less rapid than in the two preceding 

 cases, but the final result was the same. The intra-cranial injection 

 of antitoxic serum is still the subject of study. Its efficacy in acute 

 tetanus not having as yet been clearly demonstrated, it cannot be 

 recommended in practice. 



