THE ANAEROBIC BACILLI 



739 



ways be carried out whatever method of serum therapy be employed. 

 This must consist in thoroughly cleansing the wound, removal of 

 foreign bodies, fragments of projectiles, clothing, gross dirt, etc., 

 and, as the late war has shown, it is perhaps best whenever possible 

 to carry out debridement or excision of the wound. From Tulloch 's 40 

 studies it would appear that no dressing is particularly superior 

 to any other, and we doubt very much whether oxidizing agents, 

 like the insufflation of oxygen, peroxides, etc., are of much use, 

 because of the reducing powers of tissues. 



As to specific serum treatment, it must be admitted that earlier 

 results were very disappointing, and the mere subcutaneous injec- 

 tion even of large doses of tetanus antitoxin has usually been dis- 

 appointing in the acute forms of the disease. This has perhaps been 

 largely due to the fact that the injected antitoxin could have no 

 possible influence on the toxin which had already become united 

 with the substances of the nerve tissues. A great many modifications 

 in the method of injection have been employed, such as injection 

 directly into the central nervous system and into the nerve trunks, 

 themselves. It may be stated that the relative acuteness of the 

 tetanus infection very definitely influences the results of serum 

 therapy. The following table taken from Etienne and copied from 

 Courtois-Suffit and Giroux in the series of British War Manuals 

 mentioned above, gives a general idea of the usefulness of serum 

 therapy in this disease: 



This table cited from Courtois-Suffit and Giroux, Military Medical Manuals, 

 Univ. of London Press, London, 1918, page 193. 



It would be useless to go into the various methods of adminis- 

 tering tetanus antitoxin that have been tried, and we will confine 



40 Tulloch, Jour. R. A. M. C., December, 1917, Jour. Hygiene, 18, 1919, 103. 



