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W. E. B. Hall, M.D.
JAMA. 1940;115(16):1390. doi:10.1001/jama.1940.02810420076024.
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To the Editor:—  In The Journal, September 7, page 888, appeared a review of a paper by W. M. Firor (Intrathecal Administration of Tetanus Antitoxin, Arch.Surg.41:299 [Aug.] 1940). On the basis of his experiments on dogs, and the clinical reports of Yodh and of Vener, the author felt warranted in urging intrathecal injection by cisternal or lumbar routes of antitetanus serum in early mild or moderately severe tetanus instead of using intravenous routes, although he plans further investigation into the subject, using more highly purified serums. I do not feel that this recommendation should be adopted at present without serious reservation.As Firor mentions, Dietrich records severe reactions on utilizing the intrathecal route. J. M. Wainright (Incidence and Treatment of Tetanus, ibid.12:1062 [May] 1926), recognized the possibility of serious developments with intrathecal therapy, stating "The best way to increase the mortality of tetanus is to give


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