392 TETANUS. 



obtained, viz., a serum of which one gramme would protect 

 100,000,000 grammes weight of mice. 1 The potency is 

 maintained for several months if precautions are taken to 

 avoid putrefaction, exposure to bright light, etc. To this end 

 .5 per cent carbolic acid is usually added. In a case of 

 tetanus in man, 100 c.c. of such a serum should be injected 

 within twenty-four hours in five doses, each at a different 

 part of the body, and this followed up by further injections 

 if no improvement takes place. 



Many cases of human tetanus have been thus treated, but 

 with only a small measure of success. The improvement in 

 the death-rate has not been nearly so marked as that which 

 has occurred in diphtheria under similar circumstances. As 

 in the case of diphtheria, however, the results would probably 

 be better if more attention were paid to the dosage of the 

 serum. The great difficulty is that, as a matter of fact, we 

 have not the opportunity of recognising the presence of the 

 tetanus bacilli till they have begun to manifest their gravest 

 effects. In diphtheria we have a well-marked clinical feature 

 which draws attention to the probable presence of the bacilli 

 a presence which can be readily proved, and the curative 

 agent can thus be early applied. In tetanus, the wound in 

 which the bacilli exist may be, as we have seen, of the most 

 trifling character, and even when a well-marked wound exists, 

 the search for the bacilli is a matter of difficulty. Still, it 

 might be well, when practicable, that every ragged, unhealthy- 

 looking wound, especially when contaminated with soil, 

 should, as a matter of routine, be examined bacteriologically. 

 In such cases, undoubtedly, from time to time cases of 

 tetanus would be detected early, and their treatment could 

 be undertaken with more hope of success than at present. 

 However, in the existing state of matters, whenever the first 

 symptoms of tetanus appear, large doses, such as those above 

 indicated, of a serum whose strength is known, should be at 

 once administered. In giving a prognosis as to the prob- 



1 The antitetanic serum sent out by the Pasteur Institute in Paris has 

 a strength of i : 1,000,000,000. Of this it is recommended that 50 to 

 100 c.c. should be injected in one or two doses. 



