Tetanus. 313 



the teeth, epileptoid convulsions. The toxin in this case had 

 manifestly united with the brain substance while the cord suffered 

 little. 



Metchnikoff (Ann. de I'Inst. Past., April, 1898) holds that 

 the brain matter is only valuable in holding the toxin until it can 

 be destroyed by the leucocytes. He showed that the injection 

 of the tetanus toxin in chickens or Guinea-pigs greatly encreased 

 the production of leucocytes. He injected tetanus toxin into the 

 aqueous humor of the rabbit without producing much effect, but 

 when the same agent mixed with cerebral substance was injected, 

 the result was a great accumulation of leucocytes, and hypopion. 

 If the mixture of brain substance and tetanus toxins were in- 

 jected on the brain, little encrease of leucocytes occurred, but if 

 thrown into the peritoneum, a most remarkable leucocytosis took 

 place. In twenty minutes after the injection the fluid withdrawn 

 from the abdomen showed large numbers of leucocytes filled with 

 brain substance, but no free cerebral matter. 



The present status of the treatment by brain substance is there- 

 fore somewhat uncertain. The value of that agent in holding 

 the toxin is allowed, but like the antitoxin it must be employed 

 before the toxin has reached the nerve centres and united with 

 the living ganglion cells. Its use would be called for therefore 

 at the earliest possible moment and it should be continued so long 

 as there is reason to suspect the production of fresh toxin in the 

 wound. Its direct action on the toxin would suggest its injection 

 around an infected wound, or even as a dressing for the wound 

 in connection with antiseptics. When tetanus has already set in 

 it cannot be expected to undo the evil already accomplished by 

 the union of the toxin with the cells of the cord, though it might 

 in part arrest and hold new supplies of this poison coming from 

 the wound to the nerve centres. 



Prevention. In a disea.se so deadly as tetanus and so refractory 

 to treatment even by antitoxin when it is once developed, pro- 

 phylactic measures are of the greatest importance. With the 

 extensive adoption of antiseptic surgery there has already been a 

 material diminution in the number of cases, yet a greater atten- 

 tion is demanded to the prevention of casual cases which result 

 from ordinary wounds. Dirty, grimy wounds filled with the 

 dust of stable yard or garden soil, and such as contain splinters 



