56 BACTERIOLOGICAL DIAGNOSIS. 



were not for the discomfort and pain caused by the 

 throat lesion of diphtheria the antitoxin treatment of 

 the disease would have probably been abandoned as 

 useless. 



But tetanus may be diagnosed by means of a bac- 

 teriological examination of the local lesion before toxic 

 symptoms have appeared, and in cases where this is 

 done we may safely look for results from tetanus anti- 

 toxin which are as good as those obtained from the 

 early use of diphtheria antitoxin ; for the experimental 

 evidence in favour of the one is every whit as great as 

 that in favour of the other. 



Considerations of time would prohibit the bacterio- 

 logical examination of the multitude of small wounds 

 which are seen by the majority of medical men. But 

 a wound which clinical experience and bacteriological 

 research as to the occurrence of tetanus bacilli outside 

 the body, indicates as being one which is likely to 

 become infected with the bacillus in question, should be 

 submitted to a careful and prolonged search for the 

 bacillus. These are deep incised and lacerated wounds, 

 especially those of the hand and foot, and especially if 

 garden earth or horse-dung has been rubbed into the 

 tissues. Wounds made with splinters should be exa- 

 mined, especially if there is reason to think that the 

 splinters were dirty. The same remark applies to deep 

 stabs with rusty nails, &c. Tetanus may follow a 

 wound which heals up by first intention, but this is 

 unlikely ; suppuration or necrosis of the edges (though 

 not due to the tetanus bacillus itself) is present in the 

 majority of cases. 



