50 APPLIED IMMUNOLOGY 



are required in the first twenty-four hours; intra- 

 venously, probably 15,000 to 25,000 units should be 

 administered at first; intraspinally, from 3000 to 10,- 

 000 units should be given, according to the severity of 

 the case. The writers mentioned recommend for in- 

 traneural injections as great amounts as the nerves 

 will absorb^ ranging from 750 to 1500 units. For 

 intraspinal injection the same technic is employed 

 as for lumbar puncture and spinal angesthesia. For 

 intraneural administration the motor nerve trunk 

 supplying the region of the wound is exposed as near 

 to the spinal cord as practicable, and the antitoxin 

 slowly injected directly into the sheath. 



We do not regard it as out of place here to quote 

 in full Ashhurst and John's recommendations for the 

 rational treatment of a case of tetanus: 



The patient will be placed in quiet, with competent nursing facilities. 

 As soon as possible after coming under observation, whether this be in 

 the small hours of the night or at bright noon-tide, the motor nerves lead- 

 ing from the wounded part will be exposed, as near to the cord as practica- 

 ble, and as much antitoxin as each will contain will be injected toward 

 the spinal cord. An intraspinal injection of at least 3000 units will then 

 be made according to the usual technic for spinal anaesthesia. If it is 

 possible to prick the cord with the needle, so much the better. Next the 

 wound of entrance of the infection will be widely opened, all foreign 

 bodies, sloughs, etc., will be removed by forceps, scissors, or scalpel; the 

 wound will be irrigated with hot peroxide of hydrogen, swabbed out with 

 3 per cent, alcoholic solution of iodine, and loosely filled with gauze 

 soaked in the same solution, and injection of antitoxin will be made (1500 

 to 3000 units) deeply into the muscular tissues around the wound. Con- 

 tinuous proctoclysis, as used in cases of peritonitis, will be given; and by 

 mouth or in the rectal fluid will be administered effective doses of chloral 



