SERUM TREATMENT OF TETANUS 777 



73; in 1908, 76; in 1911, 18 cases and 10 deaths; in 1912, 7 cases with 

 6 deaths, and in 1913, 4 cases with 3 deaths. 



While it is not within the province of this chapter to deal with sur- 

 gical technic, the proper cleansing and care of a wound constitute so 

 important a part of the prophylaxis of tetanus that I shall refer to this 

 subject, quoting largely from the technic recently described by Ashhurst 

 and John. 1 



Surgical Treatment. 1. The surrounding skin should be painted 

 with a 3 per cent, alcoholic solution of iodin. 



2. All foreign material should be removed from the wound, and to do 

 this properly all parts of the wound should be made accessible by wide 

 incision, under ether, if necessary. This is especially true of a puncture 

 wound. It should then be freed from all tags and loose shreds of tissue 

 by means of the scissors, and the whole wound swabbed with the 3 per 

 cent, iodin solution. The wound should next be dressed with gauze 

 soaked in the same solution. The use of strong caustics is inadvisable, 

 as they cause sloughing and tend to produce a good focus for the growth 

 of tetanus bacilli. 



3. The wound should be dressed daily at first, being exposed and 

 thoroughly irrigated with hydrogen dioxid solution, and then dressed 

 with the gauze saturated with the iodin solution. As soon as healthy 

 granulations have formed, balsam of Peru applications should be 

 made. 



4. Antitetanic powders have been prepared, made up with anti- 

 septics, and although experimentally their use has seemed to be suc- 

 cessful in preventing the development or absorption of tetanus toxin, 

 still it has not as yet shown that these results were not merely due to the 

 strong antiseptic that was combined with the antitoxin powder. It 

 might, however, be well to apply tetanus antitoxin and antitetanic 

 powder to the open wound, but these remedies are not to be relied upon nor 

 accepted as substitutes for the injection of antitoxin. 



Use of Antitoxin. The prophylactic use of tetanus antitoxin has 

 not infrequently been unsuccessful, due probably to the fact that it was 

 used incorrectly. 



1. Antitoxin should be given as soon as possible after the wound has 

 been inflicted, and best at the time the primary treatment is given. 

 The antitoxin should be injected "as near the wound as possible, so as 

 to flood the tissues in the immediate vicinity, " and, if possible, it should 

 be given intramuscularly, so that the motor nerves may absorb it rapidly. 

 1 Amer. Jour. Med. Sci., 1913, cxlvi, No. 1. 



