416 INFECTION AND IMMUNITY. 



quired immunity depends on the. presence of anti- 

 toxin in the circulation. 

 prophylactic Tetanus antitoxin is a thorough prophylactic. 



Value of ,,.., , , , , , . , . 



Antitoxin. This fact has been heralded so extensively in re- 

 cent years that there can be little excuse for ignor- 

 ance on the part of any physician. At the same 

 time, the returns from the "Fourth" show that the 

 principle is not yet deeply imbedded in the medical 

 mind. It is quite certain that a large percentage 

 of these fatalities could be prevented by two injec- 

 tions of antitetanic serum, one at the time of in- 

 jury and a second from five to eight days later. 

 An epidemic of puerperal tetanus in an obstetric 

 ward in Prague was checked by prophylactic injec- 

 tions of the antitoxin. In a certain section of 

 France 4,000 horses, with injuries commonly fol- 

 lowed by tetanus, received antitoxin and none de- 

 veloped the disease. 



No degree of efficacy on the part of the anti- 

 toxin, however, justifies disregard of the surgical 

 care which the wound demands. From the facts 

 cited it is clear that thorough and frequent disin- 

 fection of the wound, free drainage, the removal 

 of all foreign and necrotic material, and the ac- 

 cess of air are measures of eminent importance. 

 Punctured wounds should be opened up. Anti- 

 toxin, preferably as a powder, may be used in the 

 wound, and the serum infiltrated into the adjacent 

 tissue. 



Curative The principles which apparently underly the ill 

 success of the antitoxin as a curative agent were 

 treated of in Chapter XXII, Part II. Its adminis- 

 tration as early as possible after symptoms have 

 appeared is demanded. After symptoms have ex- 

 isted for more than thirty hours Behring main- 



