432 TETANUS 



bable presence of the bacilli, and the curative agent can thus 

 be early applied. 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 may be 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, un- 

 doubtedly, from time to time the tetanus bacillus would be early 

 detected, and 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 probable result, the two clinical observations on which 

 chief reliance ought to be placed are the presence or absence of 

 interference with respiration, and the rapidity with which the 

 groups of muscles usually affected are attacked. If dyspnoea 

 or irregularity in respiration or rise of temperature comes on 

 soon, and if group after group of muscles is quickly involved, 

 then the outlook is extremely grave. In addition to these 

 points, the duration of the incubation period is of high im- 

 portance in forming a prognosis. The shorter the time between 

 the infliction of a wound and the appearance of symptoms the 

 graver is the outlook. 



The theory as to the nature of antitoxic action will be 

 discussed later in the chapter on Immunity. 



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.y. carbol-fuchsin diluted with five parts 

 of water. Drumstick-shaped spore-bearing bacilli are to be 

 looked for. The presence of such, having characters corre- 

 sponding to those of the tetanus bacilli, though not absolutely 

 conclusive proof of identification, 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, 



