236 PASSIVE IMMUNIZATION 



slowly inject an equivalent volume of serum (10 to 20 c.c.) at a rate 

 of about 2 c.c. per minute. According to the requirements of the 

 case, this may be repeated several times within the same twenty- 

 four hours, and continued on the following days. 



As antitoxin treatment in tetanus can be expected to do good 

 only so long as the toxin has not combined with the sensitive recep- 

 tors of the central nervous system (barring those exceptional cases 

 where this union can still be broken), and so long as it can be readily 

 reached by the antitoxin, i. e., before it has begun its travel along 

 the axis-cylinders of the affected nerves, it follows that its use must 

 be largely limited to prophylactic purposes. As the treatment, how- 

 ever, is of signal value, when employed to this end, the practitioner 

 should resort to its use in all those injuries which are likely to favor 

 infection with tetanus bacilli. It is hence recommended in con- 

 nection with all wounds which have been contaminated with earth, 

 manure, decomposing vegetable matter of any kind, particles of 

 clothing, especially in puncture wounds, such as those produced 

 by splinters of wood, rusty nails, and broken crockery; then in con- 

 nection with all wounds caused by exploding fire-arms, cartridges, 

 fire-crackers, rockets, in wounds caused by unclean instruments, as 

 on battle fields, after division of the umbilical cord, removal of the 

 placenta, etc. In all such cases the use of tetanus antitoxin is strongly 

 to be advocated, and should become a uniform practice. 



When once tetanus symptoms have developed, very little can be 

 expected. If the attempt is to be made, however, it should not be 

 delayed unnecessarily, and the subdural route chosen by preference. 

 When large nerve trunks have been exposed, intraneural injections 

 should be given in addition, besides which subcutaneous injections 

 also may be employed. Intravenous injections, as I have already 

 pointed out, can hardly do any good. 



Results. If now we turn to an analysis of the results which the 

 introduction of the antitoxin treatment has produced, we may 

 practically confine our attention to the prophylactic side of the ques- 

 tion. The evidence here is quite conclusive that its timely use may 

 be the means of saving many lives. In our own country, where the 

 anniversary of the birth of the nation's independence has in the past 

 been annually celebrated by a tetanus orgy, the death-rate in the 

 absence of prophylactic treatment has been perfectly appalling. 

 Liell, in an analysis of 350 cases, thus reports that of this number 



