PRACTICAL APPLICATIONS 413 



Antitoxin is rarely, if ever, found in human patients who have 

 survived an attack of the disease. 



Treatment. The main question, of course, concerns the use of 

 antitoxin, and two general rules may be laid down : (i) It is of 

 great value as a prophylactic agent, and (2) it is of some value in 

 chronic tetanus /.., the form with mild symptoms developing after 

 a long period of incubation. 



Its preventive application is indicated in the treatment of all 

 wounds which experience has shown to be followed by tetanus 

 i.e., lacerated and contused wounds, especially if contaminated 

 with garden soil, road debris, etc. Gunshot wounds are especially 

 dangerous, and tetanus is usually extremely prevalent in warfare. 

 It is, of course, somewhat difficult to estimate precisely the value 

 of the treatment, inasmuch as tetanus is not a common disease ; 

 but experience derived from horses, which animals are extremely 

 prone to it, is more conclusive. In some veterinary practices it 

 was so common as to counterindicate any operative measure, and 

 has now been completely eradicated. The duration of the 

 immunity conferred by a single dose is about three weeks, and 

 in the prophylactic treatment of wounds, whether accidental or 

 due to operation, two doses should be given, at intervals of ten 

 to fourteen days. The prophylactic treatment of dirty wounds by 

 means of antitoxin is now a routine method in several Continental 

 clinics, and, as far as I am aware, there has been no case 

 recorded in which it has been followed by the development of the 

 disease, excepting those in which the injection has been given 

 some days after the injury, when the toxin has already gained 

 access to the nerves. One case (under Mr. Lenthal Cheatle) 

 from which I isolated a bacillus identical in cultural and morpho- 

 logical characters with that of tetanus, and in which the organisms 

 occurred in great abundance, was treated with antitoxin at the 

 outset, and healed without a symptom of the disease : the culture 

 was unfortunately not tested by inoculation. 



Calmette prepares a powder of dry antitetanus serum to be used 

 as a dressing for wounds, but its use is very doubtful. Anti- 

 toxin is a good culture medium for bacteria, and unless the wound 

 is fairly clean may decompose and become offensive. The most 

 scrupulous antiseptic technique should be adopted, and it seems 

 probable that the dry dressing presents no advantage over the 

 subcutaneous administration of the serum when this is done. 



The doses should be 5 to 10 c.c. for a man, and 10 to 20 c.c. for 



