39 8 Tetanus 



toxin in the bodies of the infected animals. This is well 

 shown by the experiments of Donitz,* who found that if a 

 mixture of toxin and antitoxin were made before injection 

 into an animal, twelve minimum fatal doses were neutralized 

 by i c.c. of a i : 2000 dilution of an antitoxin. If, however, 

 the antitoxin was administered four minutes after the 

 toxin, i c.c. of a i : 600 dilution was required; if eight 

 minutes after, i c.c. of a i : 200 dilution ; if fifteen minutes 

 after, i c.c. of a i : 100 dilution. He found that similar 

 but slower fixation occurred with diphtheria toxin. 



It was found by Roux and Borrel f that doses of tetanus 

 antitoxin absolutely powerless to affect the progress of the 

 disease, when administered in the ordinary manner by 

 subcutaneous injection, readily saved the animal if the 

 antitoxin were injected into the brain substance. 



Chauffard and Quenu,{ who injected the antitoxin into 

 the cerebral substance, found that such administration 

 brought about an apparent cure in one case. 



Their observations were followed by an attempt to apply 

 the method in human medicine, and patients with tetanus 

 were trephined and the antitoxin injected beneath the dura 

 and into the cerebral substance. The results have not, how- 

 ever, been satisfactory, and as the method cannot be looked 

 upon as itself free from danger, it has been abandoned. 



The only means of treating the disease that can be recom- 

 mended at present is by intravenous and subcutaneous injec- 

 tion of large and frequently repeated doses of the antitoxic 

 serum. There can be little doubt but that the administra- 

 tion must be so free as to load up the patient's blood with the 

 antitoxin in hopes that its presence there may be able to de- 

 tach the toxic molecules from their anchorage to the nerve 

 cells and form an inert union. 



Prophylactic Treatment. While tetanus antitoxin is 

 extremely disappointing, in practice, for the cure of tetanus, 

 it is most satisfactory for its prevention. " An ounce of 

 prevention is better than a pound of cure," and if the sur- 

 geon would administer a prophylactic injection of tetanus 

 antitoxin in every case in which the occurrence of tetanus 

 was at all likely, the disease would rarely develop. 



* Reference 18, in "Jour, of Hygiene," vol. n, No. 2, in Ritchie's 

 article. 



t "Ann. de 1'Inst. Pasteur," 1898, No. 4. 

 t " La Presse med.," No. 5, 1898. 



