368 TETANUS. 



rapidity with which the groups of muscles usually affected 

 are attacked. If dyspnoea or irregularity in respiration 

 comes on soon, and if group after group of muscles are 

 quickly involved, then the outlook is extremely grave. 



Of the nature of the antitoxine of tetanus we know 

 little. It is not affected by heat, light, or atmospheric 

 conditions. Brieger and Boer state that they have isolated 

 it from the serum by the methods used to obtain the toxine. 



Methods of Examination in a case of Tetanus. The 

 routine bacteriological procedure in a case presenting the 

 clinical features of tetanus ought to be as follows : 



(a) Microscopic. Though tetanus is not a disease in 

 which the discovery of the bacilli is easy, still microscopic 

 examination should be undertaken in every case. From 

 every wound or abrasion from which sufficient discharge 

 can be obtained, film preparations ought to be made and 

 stained with any of the ordinary combinations, e.g., carbol- 

 fuchsin diluted with five parts of water. Drumstick-shaped 

 spore-bearing bacilli are to be looked for. The presence of 

 such, having characters corresponding to those of the tetanus 

 bacilli, though not absolutely conclusive proof of identifica- 

 tion, is yet sufficient for all practical purposes. If only 

 bacilli without spores, resembling the tetanus bacilli, are seen, 

 then the -identification can only be provisional. 



The microscopic examination of wounds contaminated 

 by soil, etc., may, as we have said in some cases, lead to the 

 anticipation that tetanus will probably result. 



(1)) Cultivation. The methods to be employed in 

 isolating the tetanus bacilli have already been described 

 (p. 355). It may be added, however, that if the character- 

 istic forms are not seen on microscopic examination of the 

 material from the wound, they may often be found by 

 inoculating a deep tube of one of the glucose media with 

 such material, and incubating for forty-eight hours at 37 C. 

 At the e^nd of this period, spore-bearing tetanus bacilli may 

 be detected microscopically, though of course mixed with 

 other organisms. 



(c) Inoculation. Mice and guinea-pigs are the most 



