58 VACCINE AND SERUM THERAPY 



refer to this latter treatment later. Behring considers 

 that no good results are to be hoped for from the use 

 of antitoxin if it is administered more than thirty 

 hours after the onset of symptoms, or if less than 

 100 units (on his system) are given. Even if these 

 postulates are fulfilled, no great results can be 

 looked for. 



In treating an animal with tetanus, the first duty 

 i^ to locate the point of infection if possible ; having 

 done this, next proceed to open up the part, so as to 

 enable the removal of an}^ pus or necrotic material. 

 The parts should then be cauterised, after which anti- 

 toxin should be injected into the w^ound and into its 

 immediate surrounding neighbourhood. Next intra- 

 venous injections of the antitoxin should be given : 

 doses of 200 units of Behring' s serum, 100 c.c. of 

 Pasteur's serum, and 18,000 U.S.A. units should be 

 given. These doses should be given at least twice 

 daily, and if given three times daily better results can 

 be hoped for. Next inject intrathecally 20 c.c. to 40 c.c. 

 This is best done in either the lumbar region (lumbar 

 puncture) or in the space between the occipito- 

 atlantal articulation. The site for the former method 

 is the space between the fourth and fifth lumbar 

 vertebrae, or at a point where a straight line drawn 

 from the most anterior part of the external angle of 

 ilium on one side to the same point on the other side 

 cuts the line of the lumbar vertebrre at right angles. 

 For this injection a needle 10 to 15 cm. long is re- 

 quired or a small trocar and cannula may be used, 



