ANTITOXIC SERA 51 



and bromides, at appropriate intervals.^ Feeding will be enforced, by 

 the nasal tube passed under chloroform anaesthesia, if necessary. During 

 the course of the first day a moderate amount of antitoxin will be admin- 

 istered intravenously; probably 10,000 units will suffice. 



The intraneural and intraspinal injections of antitoxin will be re- 

 peated daily, under chloroform anaesthesia, until marked decrease in 

 spasticity occurs. Every twelve hours, or less often, a moderate amount 

 of antitoxin will be injected intravenously, or even subcutaneously, so as 

 to neutralize the circulating toxins; but the main reliance will be placed 

 on intraneural and intraspinal injections. The administration of spinal 

 depressants will be continued as long as they are indicated; a comatose 

 state or muscular relaxation naturally are contra-indications. The wound 

 will be dressed daily, as above described, until a healthy granulating sur- 

 face is obtained. 



The administration of cardiac, pulmonary and 

 renal stimulants to meet the particular conditions, is 

 invariably a matter of necessity. 



The application of the treatment as above outlined 

 and commenced within twelve hours of the onset of 

 symptoms, should reduce the mortality of tetanus to 

 less than 20 per cent. 



Antigonococcic Serum. — Attempts have been 

 made by Torrey and others to produce an antitoxic 

 serum by injecting a toxin separated by filtration from 

 cultures of gonococci. But it has been found that 

 while this substance is toxic for laboratory animals, it 

 does not produce antibodies that render the animal in- 



^ The authors feel from their experience that complete reliance should 

 not be placed on these drugs, and recommend intraspinal injections of 

 chemically pure magnesium sulphate in 25 per cent, solution to allay mus- 

 cular spasm and convulsive seizures, in quantities of 2 to 5 c.c, the maxi- 

 mum being 1 c.c. for each 25 pounds of body weight. Should signs of 

 respiratory failure supervene, chloretone administered by mouth or by 

 rectum, preferably the latter in one drachm doses, may be substituted for 

 or alternated with the injections of magnesium sulphate. 



