- Email: [email protected]
The Cure of Tetanus
EDITORIAL ARTICLES
THE CURE OF TETANUS. THE series of experiments by Professor Nocard which we publish in this number will be read with interest by those who have been anxious to learn the truth regarding the value of antitetanic serum in the treatment of tetanus, but it is to be feared that they will come as a shock to those who have committed themselves to the opinion that the serum is reliable as a curative in that very intractable disease. It is possible that some of those who have been fortunate enough to see their patients recover after the serum treatment, will still give the new agent the credit of having averted a fatal termination, but unbiassed minds must recognise that Professor Nocard has justified his contention that a curative agent for tetanus has yet to be discovered. 1 To determine what is the value of the serum method of treatment is a problem that would require a very large body of clinical evidence for its solution. Professor N ocard says that clinical observation is inadequate to resolve it, but that is perhaps going too far. Clinical experience was probably quite competent to settle this question in the long run, just as it has determined the value of quinine in the treatment of malaria, or of mercury in syphilis; or as the clinical experience which Professor Nocard himself appeals to has shown the value of antitetanic serum as a prophylactic. Indeed, one can imagine that the mere record of the results of treatment in a not very large series of naturally occurring cases of tetanus might have established the superiority of the serum over every other method of treatment, in the same way as a comparatively brief experience of iodide of potassium served to convince everyone that it left every other agent far behind in the treatment of actinomycosis. But it was quite obvious from the outset that, whatever was the value of the serum in the treatment of declared tetanus, it had no claim to rank as a specific. The few instances in which it had been tried showed that it could not be relied upon to cure every case; all that could with any plausibility be maintained was that it appeared to conduct to recovery some cases that would otherwise have had a fatal termination, and even that estimate probably overstepped the limits of caution. Had tetanus been as invariably fatal as rabies, the practitioner who saw three recoveries under the serum treatment might have been justified in rushing into print with the cry that a specific had been discovered, but, as we all know, a certain number of casesand occasionally a considerable proportion of successive casesterminate in recovery under the most varied treatment, or without any treatment at all, and it argued a very ill-balanced judgment to 1 Strong clinical evidence in the same direction is furnished in the most recent issue of the Berliner Thierarztliche Wochenschrift (No. 39, 1897) wherein it stated that, out of nineteen cases of tetanus in the horse treated at the Berlin Vetednary College by intravenous injection of tetanus antitoxin between June and September of this year, sixteen have proved fatal.
EDITORIAL ARTICLES.
vaunt anti tetanic serum as a curative agent of high value because two out of three horses treated with it had recovered. In discussing the value of antitetanic serum, it ought to be remembered that that agent is not a substance of fixed strength, and that it is therefore possible, and even probable, that some of the serums in the market are much weaker than the samples used in Professor N ocard's experiments; at any rate, it is very unlikely that the serum now being offered to the practitioner is stronger than that which has entirely failed as a curative when submitted to the rigid test of experimentation. N or is there much room for hope that serum of greater antitoxic power than that used in M. Nocard's experiments will be obtained by present methods. In a sense, though not in the chemical one, antitetanic serum is capable of neutralising the tetano-toxin, and of averting the effects of that poison when the two agents act simultaneously on the animal body, but apparently the serum is not a remedy against the ejfeets of the toxin, and hence its failure in cases where the toxin has already for several days been exerting its injurious influence on the system. In natural tetanus, occurring as a wound infection, the period of incubation is seldom less than a week, and during- the whole of that time the toxin elaborated by the bacilli is steadily exercising its injurious effects. Before the practitioner is called in to treat the case the animal in many instances has already experienced the action of a fatal dose, and intervention is then too late. The second part of Professor N ocard's article is as encouraging to the use of antitoxic serum as a prophylactic as the first part is damaging to its claims to be considered curative. Here the results of experiment entirely accord with those obtained in practice, and conclusively prove that antitetanic serum is a reliable preventative, when injected before infection, or within a brief period afterwards. Fortunately, there are few districts or places in this country in which tetanus is so prevalent as it appears to be in some localities in France, but when the reliability of an injection of serum to confer a period of protection against the disease becomes generally known, it will doubtless be frequently employed both in human and in veterinary practice. When used with this object its cost is not prohibitive, for a comparatively small dose is all that is required to confer protection.
THE DUTIES OF VETERINARY SURGEONS UNDER THE NEW PUBLIC HEALTH (SCO~LAND) ACT. THE recently passed Public Health (Scotland) Act contains provisions that must be disappointing to those who, like Mr Ernest Hart, are anxious to see the inspection of milch cows and meat committed to " medical men with special training in cow conditions."
THE CURE OF TETANUS. THE series of experiments by Professor Nocard which we publish in this number will be read with interest by those who have been anxious to learn the truth regarding the value of antitetanic serum in the treatment of tetanus, but it is to be feared that they will come as a shock to those who have committed themselves to the opinion that the serum is reliable as a curative in that very intractable disease. It is possible that some of those who have been fortunate enough to see their patients recover after the serum treatment, will still give the new agent the credit of having averted a fatal termination, but unbiassed minds must recognise that Professor Nocard has justified his contention that a curative agent for tetanus has yet to be discovered. 1 To determine what is the value of the serum method of treatment is a problem that would require a very large body of clinical evidence for its solution. Professor N ocard says that clinical observation is inadequate to resolve it, but that is perhaps going too far. Clinical experience was probably quite competent to settle this question in the long run, just as it has determined the value of quinine in the treatment of malaria, or of mercury in syphilis; or as the clinical experience which Professor Nocard himself appeals to has shown the value of antitetanic serum as a prophylactic. Indeed, one can imagine that the mere record of the results of treatment in a not very large series of naturally occurring cases of tetanus might have established the superiority of the serum over every other method of treatment, in the same way as a comparatively brief experience of iodide of potassium served to convince everyone that it left every other agent far behind in the treatment of actinomycosis. But it was quite obvious from the outset that, whatever was the value of the serum in the treatment of declared tetanus, it had no claim to rank as a specific. The few instances in which it had been tried showed that it could not be relied upon to cure every case; all that could with any plausibility be maintained was that it appeared to conduct to recovery some cases that would otherwise have had a fatal termination, and even that estimate probably overstepped the limits of caution. Had tetanus been as invariably fatal as rabies, the practitioner who saw three recoveries under the serum treatment might have been justified in rushing into print with the cry that a specific had been discovered, but, as we all know, a certain number of casesand occasionally a considerable proportion of successive casesterminate in recovery under the most varied treatment, or without any treatment at all, and it argued a very ill-balanced judgment to 1 Strong clinical evidence in the same direction is furnished in the most recent issue of the Berliner Thierarztliche Wochenschrift (No. 39, 1897) wherein it stated that, out of nineteen cases of tetanus in the horse treated at the Berlin Vetednary College by intravenous injection of tetanus antitoxin between June and September of this year, sixteen have proved fatal.
EDITORIAL ARTICLES.
vaunt anti tetanic serum as a curative agent of high value because two out of three horses treated with it had recovered. In discussing the value of antitetanic serum, it ought to be remembered that that agent is not a substance of fixed strength, and that it is therefore possible, and even probable, that some of the serums in the market are much weaker than the samples used in Professor N ocard's experiments; at any rate, it is very unlikely that the serum now being offered to the practitioner is stronger than that which has entirely failed as a curative when submitted to the rigid test of experimentation. N or is there much room for hope that serum of greater antitoxic power than that used in M. Nocard's experiments will be obtained by present methods. In a sense, though not in the chemical one, antitetanic serum is capable of neutralising the tetano-toxin, and of averting the effects of that poison when the two agents act simultaneously on the animal body, but apparently the serum is not a remedy against the ejfeets of the toxin, and hence its failure in cases where the toxin has already for several days been exerting its injurious influence on the system. In natural tetanus, occurring as a wound infection, the period of incubation is seldom less than a week, and during- the whole of that time the toxin elaborated by the bacilli is steadily exercising its injurious effects. Before the practitioner is called in to treat the case the animal in many instances has already experienced the action of a fatal dose, and intervention is then too late. The second part of Professor N ocard's article is as encouraging to the use of antitoxic serum as a prophylactic as the first part is damaging to its claims to be considered curative. Here the results of experiment entirely accord with those obtained in practice, and conclusively prove that antitetanic serum is a reliable preventative, when injected before infection, or within a brief period afterwards. Fortunately, there are few districts or places in this country in which tetanus is so prevalent as it appears to be in some localities in France, but when the reliability of an injection of serum to confer a period of protection against the disease becomes generally known, it will doubtless be frequently employed both in human and in veterinary practice. When used with this object its cost is not prohibitive, for a comparatively small dose is all that is required to confer protection.
THE DUTIES OF VETERINARY SURGEONS UNDER THE NEW PUBLIC HEALTH (SCO~LAND) ACT. THE recently passed Public Health (Scotland) Act contains provisions that must be disappointing to those who, like Mr Ernest Hart, are anxious to see the inspection of milch cows and meat committed to " medical men with special training in cow conditions."