ANTITOXIC SERA 49 



evidence points overwhelmingly to intraspinal (sub- 

 dural) and intraneural injections as the best methods 

 of administering tetanus antitoxin, for by these means 

 the tissues affected by the toxin are reached directly. 

 Intravenous injection ranks next, as by this means all 

 the spinal nerves are reached at once, though the anti- 

 toxin reaches them much diluted. 



(2) Frequency of Injection, — The frequent fail- 

 ure of tetanus antitoxin to effect a cure is due in part 

 to the fact that it is not given often enough. The anti- 

 toxin can be given subcutaneously every three hours, 

 intravenously once or twice in the twenty-four hours, 

 intraspinally and intraneurally every day if necessary. 



(3) Quantity of Antitoxin Injected, — The sheet- 

 anchor in treatment is to get the maximum quantity 

 of antitoxin indicated into the patient's body as soon 

 as possible. One of the authors (B. A. T.), in the 

 successful treatment of a case of tetanus, reported in 

 Monthly Cyclopcedia and Medical Bulletin, June, 

 1911, administered 213,740 units of antitetanic serum. 

 Of this enormous and unprecedented quantity, 15,340 

 units were injected intraspinally, the remainder 

 subcutaneously. The largest inoculation at any one 

 time was 35,400 units and the maximum quantity in 

 twenty-four hours was 97,940 units. Subsequently, 

 Ashhurst and John state that subcutaneously, in 

 the usual acute type of case, at least 100,000 units 



