410 TETANUS 



method is usually only required in cases where a healthy person 

 contains diphtheroid bacilli in his mouth, nose, skin, etc., and 

 considerations of public health render a determination of their 

 exact nature necessary. 



Treatment. This consists in the early use of antitoxin and the 

 treatment of the local lesion with antiseptics, and the only question 

 of importance concerns the dosage of the former remedy. As a 

 rule, 4,000 to 8,000 units should be given at once, and a second 

 injection at the end of twelve or twenty-four hours ; subsequent 

 doses are given if required. Unless a case is seen very early, a 

 part at least of the first dose may be given intravenously, and 

 this is always advisable in severe cases not seen until the disease 

 has been present for two or three days. Larger doses may be 

 given, but are of doubtful advantage ; a smaller amount should 

 not be given, except perhaps in mild cases. 



The sole preventive treatment in actual use consists in the use 

 of comparatively small doses of antitoxin. The protection which 

 is conferred is usually a strong one, but exceptions have been 

 recorded. It lasts about a month. Essays in vaccination have 

 been made, but not on a large scale. 



Tetanus. 



The pathology of tetanus is akin to that of diphtheria in that it 

 is a local disease with remote symptoms due to the action of a 

 soluble exotoxin on distant structures. It differs from diphtheria 

 mainly in two points : the bacilli are strictly localized to the region 

 inoculated and the immediate neighbourhood, and the toxin, which 

 acts entirely on the central nervous system, reaches it entirely, or 

 almost so, by ascending the nerves from the region in which 

 infection occurs, and not by circulating in the blood-stream. This, 

 at least, is the usual course of events, and when, as occasionally 

 happens, the toxin actually gains access to the blood, it seems 

 likely that even then it does not act on the brain direct, but enters 

 the peripheral nerves at their distal endings and then ascends 

 them to their origin. 



The diagnosis is made entirely by the recognition of the 

 organism in the wound, no agglutination or other tests being used. 

 If (as usually happens) the culture obtained from the w r ound is 

 impure, it is divided into two parts, the one of which is injected 

 alone, the other in conjunction with tetanus antitoxin. If no 

 other pathogenic bacteria are present the animal that has received 



