Tetanus. 311 



perimental subjects if employed as soon as the slightest symptoms 

 of tetanus were shown. They found, however, that it required 

 1000 to 2000 times the amount of antitoxin in such cases than was 

 required when it was mixed with the toxin prior to injection. 

 They found, moreover, that when the disease is fully developed 

 the dose must be 150 times more than is required when the first 

 symptoms are shown. It should be added that when the disease 

 has developed rapidly, after a short incubation, and is well ad- 

 vanced the antitoxin treatment is usually of little avail. The 

 changes in the nerve centres are already too great to allow hope 

 of recovery. In man the ratio of recoveries are about as follows : 

 After incubation of 10 days or under, 3 to 4.5 per cent, recover. 

 After an incubation of 11 to 15 days 50 per cent, recover (Wood- 

 head). Lambert claims 46 per cent, recoveries in 114 cases, 

 and 38.71 per cent, recoveries in acute cases with an incubation 

 of 8 days and under. 



On the whole the ratio of recoveries is greater under the anti- 

 toxin treatment than before, though far from sustaining the opti- 

 mistic views of Behring and other early experimenters. Babes 

 draws attention to the fact that spore laden splinters of wood, in 

 the wound render the antitoxin useless as a continuous succession 

 of fresh spores, bacilli and toxins are thereby supplied. A.s this 

 is one of the most common forms of casual infection it interferes 

 seriously with the succe.ss of antitoxin treatment. 



Roux and Borrel found that in animals, intracranial injection of 

 the antitoxin was the most effective method. Recovery also fol- 

 lowed its injection into the cerebrum of a tetanic boy. Babes had 

 recoveries in two cases out of three with cerebral or intracranial 

 injections. As the reflex spasms depend on the spinal centres 

 these would seem to be the ideal points of injection. 



Babes who has done a large amount of subcutaneous and intra- 

 peritoneal injection of antitoxin, employed for man doses of 300 

 to 500 cc, which would represent 8 to 10 ozs. as the dose for an 

 ordinary horse. As the antitoxin is rapidly eliminated from the 

 body, the.se should be repeated daily or every other day. Nor 

 should this supercede other curative measures. The leading 

 principles may be thus stated : ist. Antitoxin should be used at 

 the earliest possible moment. 2nd. The infected wound area must 

 be thoroughly disinfected or destroyed by caustics, and that at 



