Experiments bearing on the relation of resistance to tetanus toxin in the im munized guinea-pig to the antitoxin value of its serum. The method of immunization used was to administer at intervals of four days equal doses of tetanus toxin the toxicity of which had been destroyed by means of hydrochloric acid. He compared the action of 4 such closes with the action of S doses. In the former case, while the animals presented a resistance to 43 minimal lethal doses, there was in the whole blood of the animal just sufficient anti toxin to neutralize between 1 and 2 minimal lethal doses. In the latter case, while a resistance of 1000 minimal lethal doses was present, there existed in the serum of the whole body only sufficient antitoxin to neutralize about 100 mini mal lethal doses. Two other series of animals similarly treated gave similar results. In a further experiment, when the effect of 4 doses of modified toxin was compared with the effect of 4 doses of double the amount of toxin, a resist ance of 2500 minimal lethal doses was developed in the latter, as against a re sistance of 50 minimal lethal doses in the former, the antitoxin value of the sera being about the same. The general conclusion was that early in the process of immunization there was developed a very high degree of resistance, while there was very little antitoxin present in the blood. James Ritchie (Lancet, July 13, 1901).
Scrum-therapy is well established as a prophylactic measure in spite of 5 eases of apparent failure reported by as many observers. It was used in 20 eases of wounds soiled by earth or dust. and no ease of tetanus developed. An injection of 10 cubic centimetres (2 7, drachms) should be given on the first. third, and tenth days. If the wound does not heal promptly a fourth injection should be given on the fifteenth day. 2. The cura tive value of the serum may be consid ered under four heads as regards methods of administration: (a) Subcutaneous. Of 373 collected eases thus treated there were 145 deaths-39 per cent. In 141 of these eases the incubation period was less than 10 days and the deaths were 57 per cent. Incubation 10 days or over, 118 cases; deaths. 20 per cent. Incuba tion undetermined. 114 eases; deaths, 36 per cent. Some forms of tetanus were especially resistant to the serum, as shown by 15 cases of tetanus neonatorum with 11 deaths, and 15 cases of puerperal tetanus with 12 deaths. A point empha sized is that no danger is incurred by the use of serum. and enormous doses may be used with impunity. In 1 ease 1500 cubic centimetres were employed. (5) Intravenous. Of 31 patients treated by this method, IS died—a mortality of 42 per cent. This is slightly higher than by the subcutaneous method, but the method was probably reserved for the most serious cases. (c) Intracerebral. This has been followed by serious results, and is not to be recommended. (d) 8nbarachnoid. This is inferior to a and b in results and has an element of dan ger. The carbolic acid treatment. of Bac celli L.) discussed at length. and the state ment made that animal experiments show that it is not a specific remedy against tetanus. Clinically Sn eases have
been observed with hut S deaths. Most of those patients were from Italy, which gives a low mortality by all methods. Other series of cases slimy greater mor tality. The treatment is regarded as a good 7:ynquomatie one, but not a specific. The author concludes that preventive serum-therapy possesses a sure action, and that if it were used systematically in all suspicions wounds tetanus would disappear the same as has variola under the use of vaccine. When the disease begins we are still at a disadvantage, but sertmetherapy is the best treatment. The use of chloral and carbolic acid is of value in controlling spasms and should be considered an auxiliary method. It is well to employ these at the same time that the serum is given, and in view of the toxicity of the acid the preference should be given to chloral. Wallas (Gaz. Heb. de IM(id. et de Chin, Oct. 5, 1902; Amer. Med., Nov. S, 1902).
The general treatment of the case is quite important. The patient should be placed in a darkened quiet room. No one but the doctor and nurse should have access, and every possible source of tation which could cause a paroxysm of muscular spasm should be rigorously ex cluded. The diet should be liquid, nour ishment by enema being employed if the trismus is marked. Of remedies for com bating the spasm chloroform is most quickly efficacious, but the relief obtained is liable to be temporary only. Nitrite of amyl will occasionally abort a ysm. Large doses are most usually bene ficial, sometimes almost certain. Other, but less valuable, remedies are Calabar bean, the bromides, and curare. Con tinuous warm baths are helpful in most instances. Ice to the spine is also mended, as is bleeding and the applica tion of the galvanic current.
The carbolic-acid treatment of tetanus is strongly favored. The method of Bac celli is as follows: if the tetanus is of traumatic origin, the wound is thor oughly cleansed with a strong antiseptic solution (either corrosive sublimate or carbolic acid). The patient is then placed in as quiet an apartment as can be obtained, the ordinary rules of diet, etc., are carried out, and subcutaneous injections of a 2-per-cent. solution of car bolic acid given at two- or three- hour intervals. If the case is one of only moderate severity, commencing doses of about 3 grains in the 24 hours may be used. This dose should, however, be rapidly increased to at least double or triple the quantity. Along with the car bolic acid other remedies, as morphine or chloral, may be given, as thought necessary. From the study of Italian literature, it would seem that: 1. Car bolic acid gives better results in tetanus than does the antitoxin treatment. 2. It acts by antagonizing the toxin and by quieting the nervous system. 3. It should always be given hypodermically, and in large-enough doses, cases of tet anus being remarkably tolerant toward it. 4. Other methods of treatment should be continued, of which the discoverer lays special stress on the local disinfec tion of the wound. H. C. Wood, Jr. (Merck's Archives, May, '99).