48 CLINICAL BACTERIOLOGY AND HEMATOLOGY 



he sees a medical man early, and the diagnosis of diphtheria is 

 made before much of the toxin has entered the blood. It is 

 different with tetanus. In this the local symptoms are practically 

 nil ; there may be suppuration at the region of inoculation, but 

 this is so common as not to excite suspicion. The result is that 

 • the diagnosis is not made until the appearance of the symptoms 

 referable to the nervous system indicates that the period at which 

 antitoxin might have been used with success has gone by. 



To illustrate this we will imagine the local lesion of diph- 

 theria to be so slight as to be unnoticed by doctor and patient. 

 The result would be that the disease would only be diagnosed when 

 the severe toxaemic symptoms had manifested themselves, and 

 antitoxin would then be almost or quite useless. If it were not 

 for the discomfort and pain caused by the throat lesion of 

 diphtheria, the antitoxin treatment of the disease would have 

 probably been abandoned as useless. 



But tetanus may be diagnosed by means of a bacteriological 

 examination of the local lesion before toxic symptoms have 

 appeared, and in cases where this is done we may safely look for 

 results from tetanus antitoxin which are as good as those obtained 

 from the early use of diphtheria antitoxin ; for the experimental 

 evidence in favour of the one is every whit as great as that in 

 favour of the other. 



Considerations of time would prohibit the bacteriological 

 examination of the multitude of small wounds which are seen 

 by the majority of medical men. But a wound which clinical 

 experience and bacteriological research as to the occurrence of 

 -tetanus bacilli outside the body indicates as being one which is 

 likely to become infected with the bacillus in question should be 

 submitted to a careful and prolonged search for the bacillus. 

 These are deep incised and lacerated wounds, especially those of 

 the hand and foot, and particularly if garden earth or horse-dung 

 has been rubbed into the tissues. Wounds made with splinters, 

 rusty nails, or the wads from firearms, should be examined. 

 Severe lacerated and contused wounds in "run-over " cases con- 

 taminated by the dirt of the road, must also be regarded with 

 suspicion, for tetanus follows superficial wounds almost as 

 frequently as deep ones. Tetanus may follow a wound which 

 heals up by first intention, but this is unlikely ; suppuration or 

 necrosis of the edges (though not due to the tetanus bacillus itself) 

 is present in the majority of cases. 



