Vol. 60, 1909 - University of North Carolina at Chapel Hill

76
THE CHARLOTTE MEDICAL JOURNAL.
in in doses of 500 to 1000 units will confer gans should be removed. Through these
immunity against diphtheria for from 2 to measures the prevalence of the disease may
4 weeks, and that the period can be length- be still further dimished.
ened at will by repeated injections;—Sec- Tetanus.—The tetanus bacillus, discovond,
Behring's claim that, if antitoxin be ered by Nicholaia in 1S84, is now regarded
used early in the disease, i. e., within the as being the cause of all the so-called forms
first 24 hours, in doses of 2000 to 5000 units, of tetanus, such as puerperal tetanus, tetathe
mortality from diphtheria will not ex- nus neonatorum, idiopathic, rheumatic and
ceed 5 per cent., is borne out by experience traumatic tetanus. It is one of the most
all the world over;—Third, that taking violently poisonous of all known bacterias
cases as they occur in practice in their early the dried and purified toxin being fatal to a
and late stages and whether the infection be man weighing 150 lbs. in a dose of 0.23
nearly pure or mixed,—the severity of the milligrams, whereas it would require 4.37
disease is lessened and its clinical course milligrams of dried cobra venom, or 30 to
shortened by the use of antitoxin, and that 100 milligrams of strychnine or anhydrous
thereby many more lives are now saved prussic acid, to produce the same effect,
than formerly. This improvement is most Its mode of infection is through wounds of
conspicuous in the most fatal form, the op- the skin or mucous membrane. In certain
erated cases of laryngeal diphtheria. localities it is frequently found in the soil,
As the result of the use of antitoxin, floors of dwellings, splinters of wood, old
there has been an average reduction of mor- nails, hay, horse and cow dung, and also
tality from diphtheria of not less than 50 in the air.
per cent., and under the most favorable Since the advent of aseptic and antisepcircumstances
a reduction of one-quarter, tic surgery tetanus has become less frequent
or even less, of the previous death-rate, after surgical operation, but it is fairly com-
This has occurred not in one city at one mon after lacerated wounds, and especially
particular time, but in many cities, in dif- after child-birth. In New York City, acferent
countries, at different seasons of the cording to the vital statistics, there are
year, and always in conjunction with the about 15 to 30 cases per year of idiopathic
introduction of antitoxin and proportionate tetanus and 40 per year of tetanus neonato
the extent of its use. In many thou- torum. Its prevention, therefore, is still a
sands of cases treated no dangerous symp- matter of importance. To produce the distoms
have followed its employment, and ease there must always be some wound in
even the disagreeable rashes, which are which the bacillus finds lodgement. In one
sometimes caused by the serum, are now to stage of its development it contains very
a large extent avoidable by the use of the resistent spores, by means of which infecpurified
and concentrated antitoxin. So tion is brought about. The spores re-
fully is the value of the preventive treat- quire favorable conditions to grow, and if
ment recognized that antitoxin is at pres- these conditions are removed the germs are
eiit furnished free of charge by many States rendered harmless. Thus, in regions where
and cities for use, through their official tetanus is prevalent, early and thorough
boards of health, in public institutions, and cleansing and disinfection of all wounds,
also for general distribution through pri- however insignificant, become of more than
vate physicians, for the treatment of diph- usual importance. Such disinfectants must
theria among persons too poor to pay for be used as are not only antiseptic,
the remedy. but also antitoxic in their ac-
Finally it may be said that, with the tion. In some cases where the parts are
moregeneraluseof antitoxin, the more care- extensively lacerated, amputation maybe
ful isolation of the sick, through disinfec- necessary.
tion of the clothing, etc., the rigid scrutiny Tetanus antitoxin, prepared in the same
of the milder cases of throat diseases, a way as diphtheria antitoxin, has been apmore
stringent surveillance in the period of plied on a large scale in immunizing horses
convalescence, and the routine examination against possible infection, especially in
of the throats especially of school children, laboratories where these animals are injectthe
dangers of the disease have been re- ed for the production of commercial antiduced
to a minimum. The chief danger toxins. Similar injections are often given
is now in the mild cases, in which the dis- to man. For immunization 10 c,c. of a
ease is unsuspected, and the child may be serum of medium strength will suffice ungoing
about. Such patients are often a less the danger seems great, when the insourceof
widespread infection. The careful jection is repeated at the end of a week,
attention to the mouth and teeth of For treatment, it is well to begin with 30 to
children is also unimportant factor. In .50c. .c, and then, according to the severity
children with recurrent attacks of tonsilitis, of the case, give from 20 to .50 c.c. each
in whom the tonsils are enlarged, the or- day until the symptoms abate. The injec-