Waterbury evening Democrat., 1904-06-30
WatCh for Friday Night'S AdH

] wounds of this natlre that we reach all the bacteria, and if we fail in doing | this we seal them in from the air most effectually. Most pernicious is the authorization Of the wound that has not been subjected to surgical exploration and cleansing.
 l Prophylact1c administration of te- janus antitOXin is entitled to much seri- ous consideration. Whatever may be said concerning the treatment of ad- vanced tetanus by antitoxin, there is no room for doubt that as preventive l 1t is most efficient. We now possess numerous instances Of its unquestion- able value in checking epfdemics of tetanus that have arisen in hospitals and mater71ities. Veterinary practice affords particularly convincing exam l pies of its use in stables and veterinary l hospitals where tetanus had become l epidemic. and in which none of the l protected animals was infected. where as unprotected animals under the same conditions developed tetanus. During the past few years several physicians with large hospital practice have used \ the antitoxin prophylaticaIly for Fourth of July injuries with complete success. Taylor of New York has treated many patients in this way without tetanus ever following in any.
 l We have been unable to learn of a single instance in which person who had been given antitoxin soon after receiving a suspicious wound has de- veloped tetanus. On the other hand, we have not learned of any harmful results from it's injection Into persons not infected with tetanus 1t therefore seems safe to assume that person who receives prophylactic injection of tetanus antitoxin will be protected against tetanus, and will not be in jured by the procedure. How neces- | sary 1t may be to give ant1toxin when the wounds are treated thoroughly by surgical means within few hours after they are received may be a mat ter for discussion, but 1t can hardly be denied that it's administration ensures l almost absolute safety and will do no harm. Tn those cases in which the physician sees the wound only after one or more days have passed, or when, because of Inconquerable objection on the part of the patients or the parents, or other reason, 1t becomes impossible to make sure both of the cleansing of the wound and the absence of any toxins already formed and absorbed, there can be no question of the neces- ! sity of the prophylactic use of anti toxin.
 1 It must be remembered that when a patient develops tetanic spasms, which I is the earliest time at which tetanus can be diagnosed, the disease has been in progress from five to twelve days as I rule.
 4 As soon as possible after the patient is seen general anesthesia should be produced, and the wound cleaned out most carefully in order to put an end to further formation and absorption of toxin. This can be done effectively be- cause in tetanus the bacill are local ized quite strictly in the wound area. Every shred of necrosed tissue must be removed not to mention the wads, which are often two in number: The treatment will, of course, be similar III wounds from other causes. Free dra1n- age and access of air should be secured by loose but complete gauge packing; there are some reasons for believing that iodoform gauge is of advantage.
 Before consciousness returns, and perhaps even before the operation ls begun. the antitoxin should De admin fstered if available. By far the best l SSS~~> to have been obtained by those who have injected the anluo1ln lnto Ins spinal canal.
 Twelve hours after the first injection the Datient should be again lightly anesthetized to avoid irritation and the nrocess of withdrawing cerebro-spinal duid and introducing 10-15 c.c. of an titoxin again repeated, with also 10 c.c. s,1l,cyta neously, and, if thought deslra- hJe more saline infusion. After this +he gl1barachnoid injections, atways nreceded by the withdrawal of cerebro- l spinal fluid, should be repeated every twenty-folrr hours as long as indicateu.
 ,Tha above described course of treat men+ can be realized fully, of course, onlv in places where the best of facil- Ties are obtainable. Where antttoxin is not procl1rable the method will be rnaIch the same with the exception of the infection of the serum. AS sup- stitute for antitoxin many European physicians, particularly the Russians, are using emulsion of fresh brain tis- sue, on the principle demonstrated py Wassermann that brain tissue has specific affinity for tetanus toxin. He found that if brain emulsion and toxin were shaken together and then sedi- mented the toxin would all be re- moved from the supernatant fluid and combined with the brain tissue in a harmless form. Experiments also indi- cate that similar union can occur within the bodies of infected animals. The method employed Is to remove, un- der aseptic precautions, the brain Of 8 freshly killed rabbit, pig or sheep. and make an emulsion of 1O-16 grams (one- half ounce) In about 50 c.c. lone ounce) of sterile salt solution After strafning through sterile cheesecloth under slight pressure, this is injected subcutaneous- l ly. near the wound if possible, and re sneated every daY. aa long nH.dndicated