PSEUDOTETANUS BACILLUS. 235 



and that it also conferred an immunity of twenty-four hours' 

 duration. 



For immunizing purposes, the dose of the tetanus anti- 

 toxin is 10 c.c. of a serum of the strength of 1 : 1,000,000,000. 

 This dose may be repeated in a week. For therapeutic pur- 

 posesy the initial dose should be 50 c.c. ; and depending on 

 the severity of the case, from 20 to 50 c.c. should be injected 

 every day until the disease is under control. 



Since this antitoxin has been used the number of fatal 

 cases of tetanus has diminished considerably, although the 

 results accruing from its use are not so good as those attained 

 in diphtheria with the diphtheria antitoxin. Very probably 

 a similarly favorable condition of affairs would obtain if 

 every case of tetanus could be treated early, before the germ 

 has developed and produced sufficient toxin to cause active 

 manifestations of the disease. 



We also wish to call attention to the fact that treatment 

 should not be limited to the use of antitoxin. The bacillus 

 must be prevented from manufacturing any more toxin. 

 Surgical intervention is absolutely indicated. Penetrating 

 wounds are either excised completely or laid widely open, so 

 that the air may have free access, and thus prevent develop- 

 ment of the germ. The cautery and strong disinfecting solu- 

 tions should also be used. Every effort should be made to 

 prevent formation of the toxin, to prevent its absorption, and 

 to neutralize the toxin which has been absorbed. 



Pseudo tetanus Bacillus. 



This is a more slender organism than the tetanus bacillus. 

 It is club-shaped, with a large spore in one end. It also has 

 flagella. It stains with the anilin dyes, but not with Gram. 

 It is sometimes found in large numbers in the appendix, and 

 was considered by its discoverer to be the cause of appendi- 

 citis. It does not resemble the tetanus bacillus in culture. 

 It is a facultative anaerobe. 



