780 PASSIVE IMMUNIZATION SERUM THERAPY 



Both the intraspinal and the intraneural injections are given under 

 light chloroform anesthesia. 



General Treatment. A large number of substances have been ad- 

 vocated in the treatment of tetanus; of these, the most common are 

 injections of phenol and intraspinal injections of magnesium sulphate. 

 While phenol may be well tolerated by tetanus patients, Ashhurst and 

 John believe that all these treatments are of little value, and that spinal 

 injections of magnesium sulphate are dangerous. 



1. Chloral hydrate and potassium bromid should be given by mouth 

 or by rectum, in sufficient quantities to produce sleep and quiet. Drugs, 

 such as those of antagonistic physiologic activity, are more or less suc- 

 cessful and frequently of aid when given in conjunction with the anti- 

 toxin. 



2. While combating the disease, the general care of the patient should 

 not be forgotten. A purgative should be administered early. Simple, 

 nourishing, non-stimulating food should be given by the mouth, if 

 possible, or by the nasal tube, if necessary. Absolute quiet should be 

 maintained. Distention of the bladder from retention of urine should 

 be guarded against. If water is not well absorbed, and especially if 

 there is peritoneal or pelvic inflammation, saline injections into the colon 

 should be given. 



Results of the Antitoxin Treatment of Tetanus. As was previously 

 stated, the prophylactic value of tetanus antitoxin has been proved beyond 

 any reasonable doubt. This does not imply, however, that the simple intro- 

 duction of 1000 units of antitoxin beneath the skin will surely protect 

 the patient, as the percentage of cases developing tetanus even after the 

 serum has been given is altogether too high. As was pointed out under 

 Prophylactic Treatment, the wound must receive thorough surgical at- 

 tention, and the antitoxin must be injected in such places where it will 

 have the greatest opportunity to neutralize the toxin. Even if tetanus 

 should develop under these conditions, it is likely to be mild and the 

 prognosis would be much more favorable. 



Tetanus antitoxin has likewise been very successful in veterinary 

 practice, especially after castration and other operations, in injuries, and 

 among horses used for the purpose of producing diphtheria antitoxin 

 and other immune serums. 



While the curative value of tetanus antitoxin has not come up to expecta- 

 tions, more recent carefully prepared statistics indicate that, with serum 

 treatment, the mortality is reduced at least 20 per cent. This includes cases 

 treated by the subcutaneous injection of antitoxin, and it must be em- 



