METHODS OF EXAMINATION 437 



during the Independence Day celebrations in America, and of 

 which tetanus is a not uncommon sequel ; a very definite fall 

 in the death-rate has been thereby effected. It is during the 

 present war, however, that the success of prophylaxis has been 

 established. During the early months, in the fighting on the 

 Marne and the Aisne, tetanus was rife — its incidence in the 

 wounded brought to Britain being about sixteen per thousand. 

 Since the autumn of 1914 prophylactic injections of antitoxin have 

 been given to every wounded man — as a rule at the dressing- 

 stations — with the result that the corresponding incidence has 

 been reduced to two per thousand. The initial dose is 500 units 

 administered subcutaneously, and, as passive immunity is of 

 relatively short duration, this dose should be repeated at seven- 

 day intervals till four doses have been given. Further, when 

 at later periods operative interference, even with healed wounds, 

 is necessary, a similar dose should be given, either subcutaneously 

 forty-eight hours, or intramuscularly twelve hours, previous to 

 the operation. 



Attention has already been directed to the effects of the 

 prophylactic use of antitoxin in modifying the clinical type 

 of the disease. 



Methods of Examination in a case of Tetanus. — The routine bacterio- 

 logical procedure in a case presenting the clinical features of tetanus 

 ought to be as follows : 



(a) Microscopic. — Though tetanus is not a disease in which the 

 discovery of the bacilli is easy, still microscopic examination should be 

 undertaken in every case. From every wound or abrasion from which 

 sufficient discharge can be obtained, film preparations ought to be made 

 and stained with any of the ordinary combinations, e.g., carbol-fuchsin 

 diluted with five parts of water. Drumstick-shaped spore-bearing bacilli 

 are to be looked for. The presence of such, having characters corre- 

 sponding to those of the tetanus bacilli, though not absolutely conclusive 

 proof of identification, is yet sufficient for all practical purposes. If only 

 bacilli without spores resembling the tetanus bacilli are seen, then the 

 identification can only be provisional. 



The microscopic examination of wounds contaminated by soil, etc., may 

 in some cases lead to the anticipation that tetanus will probably result. 



(6) Cultivation. — The methods to be employed in isolating the tetanus 

 bacilli have already been described (p. 422). It may be added, however, 

 that if the characteristic forms are not seen on microscopic examination 

 of the material from the wound, they may often be found by inoculating 

 a deep tube of one of the glucose media with such material, and incubating 

 for forty-eight hours at 37° C. At the end of this period, spore-bearing 

 tetanus bacilli may be detected microscopically, though of course mixed 

 with other organisms. 



(c) Inoculation. — Mice and guinea-pigs are the most suitable animals. 

 Inoculation with the material from a wound should be made subcu- 

 taneously. A loopl'ul of the discharge introduced at the root of the tail 



