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At the Advanced Dressing Station, after the patient has had a liberal allowance of warm fluid nourishment, such as soup or tea, a full dose of anti-tetanic serum is injected. The tourniquet is removed and the wound inspected. Urgent amputations are performed. Moribund patients are detained lest they die en route.
Major Hardy asked us to take his patient on to Vlamertinge as it was doubtful when a motor ambulance would return, and we were glad to do so. After being given the usual dose of anti-tetanic serum, he was wrapped in blankets and made comfortable in the back seat. We shook hands with the Major and started off for Vlamertinge.
Infection takes place through the umbilicus, and manifests itself clinically by spasms of the muscles of mastication. It is almost invariably fatal within a few days. Prophylaxis. Experience in the European War has established the fact that the routine injection of anti-tetanic serum to all patients with lacerated and contaminated wounds greatly reduces the frequency of tetanus.
#Local Tetanus.# This term is applied to a form of the disease in which the hypertonus and spasms are localised to the muscles in the vicinity of the wound. It usually occurs in patients who have had prophylactic injections of anti-tetanic serum, the toxins entering the blood being probably neutralised by the antibodies in circulation, while those passing along the motor nerves are unaffected.
The anti-diphtheritic and the anti-tetanic act by neutralising the specific toxins of the disease antitoxic serums; the anti-streptcoccic and the serum for anthrax act upon the bacteria anti-bacterial serums.
To prevent bleeding in hæmophilics, intra-venous or subcutaneous injections of fresh blood serum, taken from the human subject, the sheep, the dog, or the horse, have proved useful. If fresh serum is not available, anti-diphtheritic or anti-tetanic serum or trade preparations, such as hemoplastin, may be employed.
In every case an immunizing dose of anti-tetanic serum should be given. Subsequently, the method employed must suit the character of the wound, existing facilities for handling the subject and the skill and aptitude of the practitioner. Anatomo-Physiological Consideration of the Pelvic Limbs.
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