464 SEROTHERAPY 



actively immunized against tetanus toxin. Its physical properties are 

 similar to those of diphtheria antitoxin. As in the case of the diphtheria 

 antitoxin, most of the tetanus antitoxin used in the United States is refined 

 (tetanus antitoxin, concentrated) by an analogous process. The United 

 States standard unit for tetanus antitoxin is that established by the United 

 States Public Health Service and distributed from the Hygienic Laboratory 

 at Washington, D. C. This unit is denned as follows: "The immunity 

 unit for measuring the strength of tetanus antitoxin shall be ten times the 

 least quantity of an antitetanic serum (tetanus antitoxin) necessary to 

 save the life of a 350-gram guinea-pig for ninety-six hours against the 

 official test dose of a standard toxin furnished by the Hygienic Laboratory 

 of the Public Health Service." 



This method is also official in Belgium and Brazil (this implies that 

 these countries use the United States Public Health Service standard 

 toxin) and all tetanus antitoxin sold in interstate commerce in the United 

 States must be standardized by it. 



While diphtheria antitoxin is primarily curative, tetanus antitoxin is 

 chiefly used as a prophylactic. All deep or lacerated wounds, especially 

 those exposed to dust or dirt, and all Fourth of July and gunshot wounds, 

 are indications for a prophylactic subcutaneous injection as soon after the 

 injury as practicable, and a similar injection in seven days; and if sup- 

 puration of the wound ensues, the treatment should be further repeated. 

 As the object is to keep the blood-stream saturated, these prophylactic 

 doses may be given subcutaneously in any convenient region. The anti- 

 toxin prophylaxis is no substitute for thorough surgical opening and 

 cleansing of the wound, but an additional precaution. In treatment 

 of the developed disease, a procedure which is much less certain of success, 

 the antitoxin should reach the nerve-centers as quickly as possible and in 

 as high a concentration as possible; therefore, intraspinal injection is 

 indicated. The blood-stream at the same time should be kept strongly 

 antitoxic by intravenous and subcutaneous injection. For prophylactic 

 purposes, 1500 units subcutaneously is used as a dose. In tetanus 5000 

 units intraspinally, which may be repeated in twenty-four hours; and 

 10,000 units intravenously, to be repeated subcutaneously as indicated. 

 As a prophylactic, an injection of the serum should be given at once and the 

 wound, after thorough antiseptic cleansing, should be dusted with dried 

 antitoxin. 



SERUM ANTITETANICUM PURIFICATUM, U.S.P. A transpar- 

 ent or slightly opalescent Liquid, with sometimes a slight granular or ropy 

 deposit; odorless, or having an odor due to the presence of the antiseptic used 

 as a preservative. The liquid is sometimes more or less viscous. The serum 

 must come from healthy animals, must be sterile, must be free from toxins 

 .or other bacterial products, and must not contain an excessive amount of 

 preservative (not more than 0.5 per cent, of phenol nor 0.4 per cent, of 



