METHODS OF EXAMINATION 445 



probable presence of the bacilli, and the curative agent can thus 

 be early applied. In tetanus the wound in which the bacilli 

 exist may be, as we have seen, of the most trifling character, 

 and even when a well-marked wound exists, the search for the 

 bacilli may be a matter of difficulty. Still it might be well 

 that every case of a ragged, unhealthy- looking wound, especially 

 when contaminated with soil, should receive a prophylactic dose 

 of antitoxin. Whenever the first symptoms of tetanus appear 

 in any case, large doses, such as those above indicated, of a 

 serum whose strength is known, should be at once administered. 

 In giving a prognosis as to the probable result, the two clinical 

 observations on which chief reliance ought to be placed are the 

 presence or absence of interference with respiration, and the 

 rapidity with which the groups of muscles usually affected are 

 attacked. If dyspnoea or irregularity in respiration or rise of 

 temperature comes on soon, and if group after group of muscles 

 is quickly involved, then the outlook is extremely grave. In 

 addition to these points, the duration of the incubation period 

 is of high importance in forming a prognosis. The shorter the 

 time between the infliction of a wound and the appearance of 

 symptoms the graver is the outlook. 



The theory as to the nature of antitoxic action will be 

 discussed later in the chapter on Immunity. 



Methods of Examination in a case of Tetanus. The 

 routine bacteriological procedure in a case presenting the 

 clinical features of tetanus ought to be as follows : 



(a) Microscopic. Though tetanus is not a disease in which 

 the discovery of the bacilli is easy, still microscopic examination 

 should be undertaken in every case. From every wound or 

 abrasion from which sufficient discharge can be obtained, film 

 preparations ought to be made and stained with any of the 

 ordinary combinations, e.g., carbol-fuchsin diluted with five parts 

 of water. Drumstick-shaped spore-bearing bacilli are to be 

 looked for. The presence of such, having characters corre- 

 sponding to those of the tetanus bacilli, though not absolutely 

 conclusive proof of identification, is yet sufficient for all 

 practical purposes. If only bacilli without spores resembling 

 the tetanus bacilli are seen, then the identification can only be 

 provisional. 



The microscopic examination of wounds contaminated by soil, 

 etc., may in some cases lead to the anticipation that tetanus will 

 probably result. 



(6) Cultivation. The methods to be employed in isolating 

 the tetanus bacilli have already been described (p, 430). It 



