TREATMENT WITH ANTITETANIN 57 



absorbed by this route, one or two days elapse before 

 the maxiiQum concentration of antitoxin in the blood 

 is reached ; whereas in treatment of the disease it is 

 important to neutralise the toxin, which has already 

 got the start of the antidote, as quickly as possible ; 

 hence intravenous injection is much to be preferred 

 to the subcutaneous route, as being speedier in action 

 — a question of minutes only. 



2. Intravenous Method. — The jugular vein is the 

 site most suitable for the injection. The most rigid 

 aseptic precautions must be observed. The injections 

 can be given either with a large hypodermic syringe 

 or by any of the appliances used for intravenous 

 injections. Both of these methods effect a neutralisa- 

 tion of the poison circulating in the blood stream, but 

 they do not avail to counteract that which has already 

 reached the nervous system. Two methods adopted 

 to achieve this end, if it be possible in any way, have 

 been recommended — namely, the injection of the anti- 

 toxin into the space between the dura mater and the 

 brain (subdural) or spinal cord (intrathecal), and 

 injection directly into the brain substance (intra- 

 cerebral). For ease and safety of administration and 

 generally for effectiveness, the injection of the serum 

 intraspinally after lumbar puncture is undoubtedly 

 the best. By making use of this last method, I have 

 personally seen five recoveries out of six cases of 

 tetanus in horses ; but in conjunction with this treat- 

 ment the animals were also kept in a condition of 

 semihypnosis by the use of chloral hydrate. I shall 



