Prophylactic Treatment 463 



late to effect a cure. At this point it is well to recall 

 Nocard's experiment with the sheep, in whose blood so much 

 toxin was already present when symptoms first appeared 

 that the amputation of their infected tails could not save 

 them. 



The explanation of this inability of the antitoxin to effect 

 a cure when administered after development of the symp- 

 toms of tetanus is probably found in a ready fixation of the 

 toxin in the bodies of the infected animals. This is well 

 shown by the experiments of Donitz,* who found that if a 

 mixture of toxin and antitoxin were made before injection 

 into an animal, twelve minimum fatal doses were neutralized 

 by i c.c. of a i : 2000 dilution of an antitoxin. If, however, 

 the antitoxin was administered four minutes after the 

 toxin, i c.c. of a i : 600 dilution was required; if eight 

 minutes after, i c.c. of a i : 200 dilution ; if fifteen minutes 

 after, i c.c. of a i : 100 dilution. He found that similar 

 but slower fixation occurred with diphtheria toxin. 



It was found by Roux and Borrel f that doses of tetanus 

 antitoxin absolutely powerless to affect the progress of the 

 disease, when administered in the ordinary manner by 

 subcutaneous injection, readily saved the animal if the 

 antitoxin were injected into the brain substance. 



This observation was followed by a ready application to 

 human medicine, and patients with tetanus were trephined 

 and the antitoxin injected beneath the dura and into the 

 cerebral substance. The results attained have not, how- 

 ever, been satisfactory, and the method cannot be looked 

 upon as itself free from danger. 



Chauffard and Quenu,{ who injected the antitoxin into 

 the cerebral substance, found that such administration 

 brought about an apparent cure in one case. 



Prophylactic Treatment. While tetanus antitoxin is 

 extremely disappointing in practice for the cure of tetanus, 

 it is most satisfactory for its prevention. "An ounce of 

 prevention is better than a pound of cure," and if the 

 surgeon would administer a prophylactic injection of tet- 

 anus antitoxin in every case in which the occurrence of 

 tetanus was at all likely, the disease would rarely develop. 



* Reference 18, in "Jour, of Hygiene," vol. n, No. 2, in Ritchie's 

 article. 



f "Ann. de 1'Inst. Pasteur," 1898, No. 4. 

 I "La Presse med.," No. 5, 1898. 



