GUN SHOT WOUNDS AND TETANUS. 151 



GUN SHOT WOUNDS AND TETANUS. 



T. B. COOLEY. 



I must confess at the start that I have little new to offer on this 

 much discussed subject. You are all of you aware, through the news- 

 papers, if by no other means, of the frequency of tetanus in this coun- 

 try, and of that form in especial which is frequently called Fourth 

 of July tetanus, because it results from wounds received in the noise 

 making: peculiar to the celebration of that holiday, and in particular 

 from the careless handling of the ''toy pistol," by which we should un- 

 derstand, not the pistol that discharges the harmless paper caps, but 

 that in which are used blank cartridges. 



The overwhelming percentage of all the tetanus cases that comes from 

 these wounds, has led many men to suppose that there may be tetanus 

 bacilli present in the powder or the wads used in loading these car- 

 tridges, and that, as it is well known that the heat of the explosion is 

 not sufficient to destroy' the organisms, they might be carried into the 

 wound. A number of investigations have been undertaken with the pur- 

 pose of demonstrating this theory — some of them quite exhaustive — 

 and the results, so far as they have been published, have been invariably 

 negative, with two exceptions, where the reported finding of the bacilli in 

 samples of g-unpowder was not confirmed by animal inoculations.* 



The only other possible explanation of these cases rests on the fact 

 that the tetanus organism is frequently found in street dirt, and we 

 may suppose it to be present on the skin and to be driven into the 

 wound with the fragments of skin. 



It is my intention in this paper to present briefly the evidence — 

 theoretical and experimental — in favor of each of these views, and to 

 descril)e some work which I have done myself by somewhat different 

 methods than those pursued by others, but which has had so far the 

 same negative results. I am indebted for my statistics largely to a very 

 exhaustive article which appeared in the Journal of the American Medi- 

 cal Association for August 20, 1903, and to Dr. Wells' paper in Ameri- 

 can Medicine of June 13, 1903. 



The salient facts are as follows: First. An enormous proportion 

 of all cases of tetanus occurs during the month of July. This is very 

 strikingh^ shown in Well's i>aper, in which, is given the curve of tetanus 

 mortality in certain of the large cities, by months, for several years. 

 Second. More than ninety per cent, of these cases result from blank 

 cartridge wounds, beside which the traditional rust}- nail is of but little 

 importance. The Journal of the xA.merican Medical Association reports 

 358 cases of Fourth of Julv tetanus in 1903, where blank cartridge 

 wounds were the cause, against twenty-nine from all other causes. Of 

 these twenty-nine, a certain i)roportion was due to wounds from the ex- 

 plosion of gunpowder in some other form. 



In favor of the presence of tetanus bacilli in the gunpowder or wads 

 are the following arguments : 



* Since ihe above was written some German observers have reported the repeated finding of 

 tetanus bacilli in the wads of blank cartridges. 



