METHODS OF EXAMINATION. 393 



able result, the two clinical observations on which, accord- 

 ing to Behring, chief reliance ought to be placed, are the 

 presence or absence of interference with respiration, and the 

 rapidity with which the groups of muscles usually affected 

 are attacked. If dyspnoea or irregularity in respiration 

 comes on soon, and if group after group of muscles is 

 quickly involved, then the outlook is extremely grave. 



Of the nature of the antitoxine of tetanus we know 

 little. It is not affected by heat, light, or atmospheric 

 conditions. Brieger and Boer state that they have isolated 

 it from the serum by the methods used to obtain the 

 toxine. 



The theory as to the nature of antitoxic action will be 

 discussed later in the chapter on Immunity. Here it need 

 only be noted that Wassermann and others have found 

 that there exist, in the nervous system of animals susceptible 

 to tetanus, bodies which seem to neutralise the action of 

 tetanus toxine. Thus i c.c. of an emulsion made by rub- 

 bing up the nervous system of a mouse in water will neutralise 

 an amount of toxine equal to ten times the minimum lethal 

 dose for a mouse if the two substances be mixed together 

 in vitro and injected. 



Methods of Examination in a case of Tetanus. The 

 routine bacteriological procedure in a case presenting the 

 clinical features of tetanus ought to be as follows : 



(a) Microscopic. Though tetanus is not a disease in 

 which the discovery of the bacilli is easy, still microscopic 

 examination should be undertaken in every case. From 

 every wound or abrasion from which sufficient discharge 

 can be obtained, film preparations ought to be made and 

 stained with any of the ordinary combinations, e.g., carbol- 

 fuchsin diluted with five parts of water. Drumstick-shaped 

 spore-bearing bacilli are to be looked for. The presence of 

 such, having characters corresponding to those of the tetanus 

 bacilli, though not absolutely conclusive proof of identifica- 

 tion, is yet sufficient for all practical purposes. If only 

 bacilli without spores, resembling the tetanus bacilli, are 

 seen, then the identification can only be provisional. 



