274 TETANUS 



§ 196. Prevention. Owing to the wide distribution of 

 tetanus bacilli, precautions can consist only of the careful and 

 thorough disinfection of all wounds. With animals at pas- 

 ture, it is impossible often to know of the wounds until it is 

 too late to apply this measure. In stables where the disease 

 becomes prevalent, the floors and siding should be thoroughly 

 disinfected and special watchfulness exercised to find at the 

 earliest moment any injury by which infection could occur. 

 The practitioner should learn as soon as possible the tetanus 

 infected lands and stables in his community and, knowing 

 these, give wise instruction to his clients to take such precau- 

 tions as are possible. In case operations are to be performed 

 on animals in such stables an immunizing dose of tetanus 

 antitoxin may be administered. This practice is followed in 

 many places in Europe. If the present knowledge of this 

 disease is properly availed of, there should be only occasional 

 cases which as yet there seems to be no way to avoid. 



§ 197. Tetanus antitoxin. It was first pointed out by 

 von Behring and Kitasato that animals could be made immune 

 to tetanus by using cultivations of the tetanus bacilli which 

 had been attenuated with iodine trichloride. The blood serum 

 of such immunized animals has the power to immunize healthy 

 animals against the disease and to render the toxin in animals 

 affected with tetanus inert. The antitoxin is prepared now, 

 however, by injecting horses with the filtrate of bouillon 

 cultures, either alone or with a quantity of antitoxin. After 

 the first dose the animal becomes tolerant to a certain degree 

 so that by repeated and constantly increasing doses complete 

 resistance to the toxin is acquired. When this point is 

 reached the serum usually possesses a strong antitoxic power. 

 As a practical remedy for the disease in animals the recorded 

 results from the use of this antitoxin are somewhat contradic- 

 tory. In human practice the results are similar. Mosch- 

 cowitz has collected 290 cases in man where it has been used 

 subcutaneously, with 173 recoveries and 117 deaths or a 

 mortality of 40.33 per cent. In a total ot 48 cases where the 



