ANTITETANIC SERUM. 367 



.5 per cent carbolic acid is usually added. In a case of 

 tetanus in man, 100 c.c. of such a serum should be injected 

 within twenty-four hours in five doses, each at a different 

 part of the body, and this followed up by further injections 

 if no improvement takes place. 



Many cases of human tetanus have been thus treated, but 

 with only a small measure of success. The improvement in 

 the death-rate has not been nearly so marked as that which 

 has occurred in diphtheria under similar circumstances. As 

 in the case of diphtheria, however, the results would probably 

 be better if more attention were paid to the dosage of the 

 serum. We have seen that in mice, when once tetanic 

 symptoms have appeared, the chance of saving a case is 

 diminished, and the same is doubtless true of man. The 

 great difficulty is that, as a matter of fact, we have not 

 the opportunity of recognising the presence of the tetanus 

 bacilli till they have begun to manifest their gravest effects. 

 In diphtheria we have a well-marked clinical feature which 

 draws attention to the probable presence of the bacilli 

 a presence which can be readily proved, and the curative 

 agent can be applied before the microbes have advanced far 

 in their pathogenic course. In tetanus, the wound in which 

 the bacilli exist may be, as we have seen, of the most trifling 

 character, and even when a well-marked wound exists, the 

 search for the bacilli is a matter of difficulty. Still, it might 

 be well, when practicable, that every ragged, unhealthy- 

 looking wound, especially when contaminated with soil, 

 should, as a matter of routine, be examined bacteriologically. 

 In such cases, undoubtedly, from time to time cases of 

 tetanus would be detected early, and their treatment could 

 be undertaken with more hope of success than at present. 

 However, in the existing state of matters, whenever the first 

 symptoms of tetanus appear, large doses, such as those above 

 indicated, of a serum whose strength is known, should be at 

 once administered. In giving a prognosis as to the prob- 

 able result, the two clinical observations on which, accord- 

 ing to Behring, chief reliance ought to be placed, are the 

 presence or absence of interference with respiration, and the 



