VALVE OF ANTITOXIN. 417 



tains that there is no hope of cure by the subcuta- 

 neous route. Inasmuch as forty hours or more are 

 required for complete absorption from the subcuta- 

 neous tissue, intravascular injection of at least the 

 first dose would seem to be indicated. Yet by 

 neither of these methods is the most essential end 

 accomplished, for the antitoxin does not reach the 

 nerves nor can it be recognized in the cerebrospinal 

 fluid in conspicuous quantities. The most that 

 such injections accomplish is the neutralization of 

 the circulating toxin, that which is not yet on its 

 way to the central nervous system through the mo- 

 tor nerves. It is, of course, important to neutral- 

 ize the circulating toxin and it must be done quick- 

 ly, for in the course of a few hours the fatal quan- 

 tity of toxin may have been absorbed ; "a dose of 

 antitoxin which would save in the morning may 

 be without effect in the evening." 



At the same time it is of greater immediate im- Method of 

 portance to neutralize that which has already en- 

 tered the peripheral nerves, and if possible to tear 

 away some of the toxin already bound by the gang- 

 lionic cells. To acomplish this object, or to at- 

 tempt it, special procedures are demanded. We 

 may then consider the antitoxic treatment as fol- 

 lows: 



First: The neutralization of the toxin which 

 has already been absorbed by the peripheral nerves 

 and spinal cord at a point as near the vital centers 

 as possible. This involves surgical exposure of the 

 large nerves of the part as near the trunk as possi- 

 ble and their infiltration with antitoxin (Ransom 

 and Meyer), and in desperate cases the infiltra- 

 tion of the antitoxin in the spinal cord in the 

 vicinity of the medullary centers. From five to 



