362 Tetanus 



But too much emphasis must not be placed upon these latter figures 

 as there were variations quite as great in the various decades making 

 up the totals. Thus between 1 840-1 849 the deaths numbered 68.7 

 per cent.; in 1 880-1 889, 83.9 per cent. Irons says that it is im- 

 portant that the full effect of the antitoxin be immediately obtained, 

 the best method of using it being that outlined by Park in which 

 3000 units are given intraspinously at the earliest possible moment 

 after the symptoms appear, and 10,000 to 20,000 units given intra- 

 venously at the same time. On the following day the intraspinous 

 injection of 3000 should be repeated. On the fourth or fifth day, 

 10,000 units should be given subcutaneously. By these means a 

 high antitoxic content of the blood and juices is maintained. 



The use of antitoxic serums must not replace other non-specific 

 modes of treatment such as local treatment of the wound and the 

 administration of sedatives, etc. The result of its experimental in- 

 jection, in combination with the toxin, into mice, guinea-pigs, rab- 

 bits, and other animals is perfectly satisfactory, and affords protec- 

 tion against almost any multiple of the fatal dose, but the quantity 

 needed, in proportion to the body- weight, to save an animal from the 

 unknown quantity of toxin being manufactured in its body increases 

 so enormously with the day or hour of the disease as to make the 

 dose, which increases millions of times where that of diphtheria anti- 

 toxin increases but tenfold, a matter of difficulty and uncertainty. 

 Nocard also called attention to the fact that the existence of tetanus 

 cannot be known until a sufficient toxemia to produce spasms exists, 

 and that therefore it is impossible to attack the disease in its incep- 

 tion or to begin the treatment until it may be too late to effect a cure. 

 At this point it is well to recall Nocard's experiment with the sheep, 

 in whose blood so much toxin was already present when symptoms 

 first appeared that the amputation of their infected tails could not 

 save them. 



The explanation of this inability of the antitoxin to effect a cure 

 when administered after development of the symptoms of tetanus is 

 probably found in a ready fixation of the toxin in the bodies of the 

 infected animals. This is well shown by the experiments of Donitz,* 

 who found that if a mixture of toxin and antitoxin were made before 

 injection into an animal, twelve minimum fatal doses were neutralized 

 by I cc. of a X : 2000 dilution of an antitoxin. If, however, the 

 antitoxin was adniinistered four minutes after the toxin, i cc. of a 

 I : 600 dilution was required; if eight minutes after, i cc. of a i : 200 

 dilution; if fifteen minutes after, i cc. of a i : 100 dilution. He found 

 that similar but slower fixation occurred with diphtheria toxin. 



It was found by Roux and Borrelf that doses of tetanus antitoxin 

 absolutely powerless to affect the progress of the disease, when ad- 

 ministered in the ordinary manner by subcutaneous injection, read- 



* Reference 18, in "Jour, of Hygiene," vol. 11, No. 2, in Ritchie's article, 

 t "Ann. de I'Inst. Pasteur," 1898, No. 4. 



