436 TETANUS 



carefully watched. Similar precautions are observed with the 

 intravenous method. In an acute case from 50,000 to 100,000 

 units should be administered during the first few days ; if the 

 symptoms are specially severe a high titre serum should be 

 used. Bruce gives the following scheme of treatment as 

 suitable : — 



In giving a prognosis as to the probable result, the two 

 clinical observations on which 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 progressively attacked. If dyspnoea, or irregularity in 

 respiration, or rise in temperature comes on soon, and if group 

 after group of muscles is quickly involved, then the outlook is 

 extremely grave. The advent of laryngeal spasm may necessi- 

 tate the performance of tracheotomy or the practice of artificial 

 respiration. Further, the shorter the time between the infliction 

 of the wound and the appearance of symptoms the graver is 

 the outlook. 



The results of the therapeutic use of antitoxin in tetanus 

 have not been so good as in the corresponding casfe of diphtheria, 

 and it is doubtful whether the course of a rapid intoxication 

 can be in any way, or by any means, modified. The great 

 difficulty is that an infection is not suspected till the tetanus 

 bacilli have already begun to manifest their gravest effects. 

 This is in contrast with diphtheria, where the multiplication of 

 the bacilli early originates a well-marked local clinical feature — 

 sore throat — which draws attention to the possibility of their 

 presence and enables the intoxication to be anticipated. Still, 

 in tetanus, antitoxin treatment should always be undertaken, as 

 it is impossible to say that thereby the course of a subacute 

 infection may not be deflected from a fatal to a non-fatal issue. 



The Prophylactic Use of Tetanus Antitoxin. — The advisability 

 of giving antitoxin prophylactically in every case of a ragged, 

 unhealthy-looking wound, especially when contaminated with 

 soil, has been advocated. The principle has, for a considerable 

 time, been applied in connection with the injuries contracted 



