588 APPLICATION OF METHODS OF BACTERIOLOGY 



Tetanus antitoxin, though the first antitoxin discovered 

 and frequently employed in the treatment of tetanus, has 

 not yielded as brilliant results as those obtained with diph- 

 theria antitoxin. There are good reasons why tetanus 

 antitoxin may never be expected to yield such satisfactory 

 results as does diphtheria antitoxin. Diphtheria infection 

 can be recognized by bacteriological methods and the anti- 

 toxin administered long before very marked constitutional 

 symptoms have developed, and consequently long before 

 the diphtheria toxin has had time to bring about serious 

 tissue alterations. In tetanus it is impossible to make such 

 a definite bacteriological examination, and very frequently 

 the first suggestion of the disease is the twitching of the 

 muscles, the antecedent sign of the tetanic convulsions. 

 When these clinical manifestations have developed in tetanus 

 there is already very serious involvement of the central 

 nervous system. 



In the use of tetanus antitoxin it is advisable to employ 

 it as early as possible and to give repeated doses until the 

 symptoms are relieved. Whether the subdural adminis- 

 tration of the antitoxin will be of greater value than the 

 subcutaneous administration is as yet undecided. 



A great deal of benefit results,, from the administration 

 of tetanus antitoxin as a prophylactic in the treatment of 

 wounds in which infection by the tetanus bacillus is possible. 

 The prophylactic injection of the tetanus antitoxin in these 

 cases, however, should always be accompanied by approved 

 surgical treatment of the wound, and under these conditions 

 it is more or less doubtful which of these measures is of 

 the greater value, but experience seems to indicate that the 

 antitoxin has a distinct prophylactic influence in these cases. 



