232 BACTERIA PATHOGENIC TO MAN 



of this disease treated with antitoxin, according to published and unpub- 

 lished reports, there was a mortality of 40.35 per cent. Of these, 47 

 were acute cases that is, cases with an incubation period of eight days 

 or less and with rapid onset, or cases with a longer period of incuba- 

 tion, but intensely rapid onset of symptoms; of these the mortality was 

 74.46 per cent. Of the chronic type those with an incubation period 

 of nine days or more, or those with shorter incubation with slow onset 

 there were 61 cases, with a mortality of 16.39 per cent. With a still 

 larger number of cases the results indicate that with tetanus antitoxin 

 about 20 per cent, better results are obtained than without. 



Treatment of Tetanus by Antitoxin. For immunization, 10 c.c. of a 

 serum of medium strength will suffice unless the danger seems great, 

 when the injection is repeated at the end of a week. For treatment, 

 it is well to begin with 30 to 50 c.c., and then, according to the 

 severity of the case, give from 20 to 50 c.c. each day until the symptoms 

 abate. In the gravest cases no curative effect will be noticed from the 

 serum. The first injections should be made intravenously, or partly 

 intravenously and partly into the spinal canal through lumbar punc- 

 ture. Later, injections should be made subcutaneously or intravenously. 

 Besides these, injections should be made into all the nerve trunks leading 

 from the infected region. These injections should be made as near the 

 trunk as possible and distend the nerve so as to partly neutralize and 

 partly mechanically interrupt the passage of toxin to the cord or brain. 

 In New York City Rogers has had good results by following these 

 cases. He has also injected the antitoxin directly into the spinal cord. 

 The method of injecting from 3 to 15 c.c. of antitoxic serum into the lateral 

 ventricles has not, in the writer's opinion, shown itself to be equal to the 

 intravenous and intraspinal and intraneural methods. No bad results 

 have followed the injections when the serum was sterile and the opera- 

 tion was performed aseptically; but several brain abscesses have already 

 followed the intracerebral injections. 



The striking results which have been obtained, particularly in veter- 

 inary practice, with the prophylactic injection of tetanus antitoxin, 

 would seem to warrant the treating of patients with immunizing doses 

 of serum at least, in neighborhoods where tetanus is not uncommon 

 when the lacerated and dirty condition of their wounds may indicate 

 the possibility of a tetanus infection. 



Differential Diagnosis. The differential diagnosis of the bacillus of 

 tetanus is, generally speaking, not difficult, inasmuch as animal inocu- 

 lation affords a sure test of the specific organism. No other micro- 

 organism known produces similar effects to the tetanus bacillus, nor 

 is any other neutralized by tetanus antitoxin. The other character- 

 istics also of this bacillus are usually distinctive, though microscopic 

 examination alone cannot be depended on to make a differential diag- 

 nosis. Difficulty arises when other anaerobic or aerobic bacilli, almost 

 morphologically identical with the tetanus bacillus, are encountered 

 which are non-pathogenic, such as the bacillus pseudotetanicus anaero- . 

 bins, already mentioned, and the bacillus pseudotetanicus aerobius. It 



