SERUM TREATMENT OF TETANUS 729 



phasized that, in order to secure the best results, tetanus must be treated 

 in a rational manner according to its pathology. Under these circum- 

 stances we can confidently expect a greater reduction in mortality. But 

 at any rate no physician should withhold antitoxin in the treatment if 

 there are any possible means of obtaining it. If only 3000 units may be 

 had, it is far better to inject this amount intraspinally than subcu- 

 taneously. 



Pennin, 1 in a recent and thorough review, reaches the general con- 

 clusion that anti-tetanus serum has reduced the mortality of tetanus 

 approximately 20 per cent. He gives figures from Denmark that are 

 especially valuable, because they were gathered from a small area, and 

 hence represent fairly uniform conditions: Of 199 cases not receiving 

 serum, only 21 per cent, recovered; whereas of 189 cases treated with 

 serum, 42.3 per cent, recovered. Of 92 acute cases with an incubation 

 period of less than ten days 24.2 per cent, recovered when serum was 

 used, whereas of 94 cases treated without serum only 5.3 per cent, re- 

 covered. It is significant that these Danish figures correspond closely 

 to the American statistics and those of other countries. Irons 2 has 

 recently tabulated the results of 225 cases of tetanus treated with anti- 

 toxin collected from hospitals and private records for the years 1907 to 

 1913. The mortality in all cases receiving serum was 61.77 per cent.; 

 in 21 cases without serum the mortality was 85.7 per cent. The latter 

 figures correspond quite closely with the general mortality of about 85 

 per cent, of tetanus treated without serum. Irons' figures also show the 

 influence of large doses of antitoxin; of 57 cases receiving a small dose 

 of antitoxin (3000 units or less subcutaneously), the mortality was 73.7 

 per cent.; of 143 cases receiving large doses (over 3000 units subcu- 

 taneously, or 3000 or less intraspinally or intravenously), the mortality 

 was 57.3 per cent. Magnesium sulphate was given intraspinally in 18 

 cases which also received serum; in 4 cases 2 acute and 2 chronic 

 the patients recovered, giving a mortality for the group of 77 per cent. 

 In 2 cases death recurred shortly after injection with symptoms of re- 

 spiratory failure. 



In view of this evidence in favor of antitoxin in the treatment of 

 tetanus it is apparent that the physician is compelled to give every 

 patient with tetanus the opportunity to obtain this 20 per cent, or more 

 benefit by administering the serum promptly and correctly. 



1 Mitt. a. d. Grenzgeb. d. Med. u. Chir., 1913, xxvii. 



2 Jour. Amer. Med. Assoc., 1914, Ixii, 20, 25. 



