$O CLINICAL BACTERIOLOGY AND 



for results from tetanus antitoxin which are as good as those 

 obtained from the early use of diphtheria antitoxin; for the 

 experimental evidence in favour of the one every whit as 

 great as that in* favour of the other. 



Considerations of time would prohibit the bacteriological 

 examination of the multitude of small wounds which are seen 

 by the majority of medical men. But a wound which clinical 

 experience and bacteriological research as to the occurrence 

 of tetanus bacilli outside the body indicates as being one which 

 is likely to become infected with the bacillus in question should 

 be submitted to a careful and prolonged search for the 

 bacillus. These are deep incised and lacerated wounds, 

 especially those of the hand and foot, and particularly if gar- 

 den earth or horse-dung has been rubbed into the tissues. 

 Wounds made with splinters, rusty nails, or the wads from 

 firearms, should be examined. Severe lacerated and contused 

 wounds in "run-over" cases contaminated by the dirt of the 

 road must also be regarded with suspicion, for tetanus fol- 

 lows superficial wounds almost as frequently as deep ones. 

 Tetanus may follow a wound which heals up by first intention, 

 but this is unlikely; suppuration or necrosis of the edges 

 (thoug'h not due to the tetanus bacillus itself) is present in the 

 majority of cases. 



Where tetanus is likely to follow, no time should be lost 

 in bacteriological examinations, but antitoxin .given at once. 

 This method was followed during the recent war; all patients 

 with wounds, whether large or small, being given a prophy- 

 lactic dose at the earliest opportunity. The result has been 

 most striking, for since this has been done tetanus has almost 

 entirely disappeared, though it was appallingly common 

 before, and tetanus bacilli are still found in abundance in 

 many wounds. 



;.- EXAMINATION OF Pus FROM SUSPECTED CASES OF 



TETANUS. 



Requisites. i. Slides and cover-glasses. 



2. A stiff platinum loop. 



3. Bunsen burner or spirit-lamp. 



4. Loffler's blue or carbol thionin. 



5. Materials for Gram's staining. 



6. Balsam. 



