MALIGNANT (EDEMA 425 



The antitoxin may be standardised by the Roux or by 

 the Behring method (see p. 280). Recently a method 

 analogous to that used for standardising diphtheria anti- 

 toxin has been introduced. 1 



Clinical Examination 



The symptoms of tetanus are usually so obvious that a bacterio- 

 logical examination is not needed to establish the diagnosis, and 

 unless there is an evident wound it will be difficult, if not impossible, 

 to detect the tetanus bacillus. 



(1) Prepare several smears of the pus or discharge, and stain 

 by Gram's method. Examine microscopically, looking for the 

 spore-bearing rods or " drum-sticks." A " drum-stick " bacillus is, 

 however, not necessarily the tetanus bacillus (see p. 420). 



(2) If " drum-sticks " be found, an attempt may be made to 

 isolate the bacillus by making anaerobic plate cultivations from 

 the discharge, after heating it in capillary pipettes to 80 C. for 

 half an hour. 



(3) Inoculate mice and guinea-pigs with the heated discharge. 

 If they die with tetanic symptoms, treat the pus at the seat of 

 inoculation as in (2). 



Malignant (Edema 



Malignant oedema is met with in man in connection 

 with wounds soiled with septic matter, compound frac- 

 tures, contused and lacerated wounds, etc. Usually there 

 is a putrefactive and oedematous condition of the tissues 

 with subcutaneous emphysema. Animals also occasionally 

 suffer from the disease, which can be produced artificially 

 by inoculation with dust, dust from straw, the upper 

 layers of garden earth, and decomposing animal and 

 vegetable matter. 



If a guinea-pig be inoculated subcutaneously with a 

 little garden earth, it will very likely die in forty- eight 



1 On the standardisation and therapeutic use of tetanus antitoxin, 

 see Hewlett's Serum Therapy, 1910. 



