THE ANAEROBIC BACILLI 737 



by members of the United States Public Health Service have shown 

 that tetanus can be produced with regularity if staphylococcus in- 

 fection is added to the infection with tetanus spores, and injury of 

 tissue by the injection of small quantities of such substances as 

 quinine, may start the growth of latent tetanus spores with subse- 

 quent development of the disease. Tetanus spores pass through the 

 intestinal canals of animals and man without injury, and are dis- 

 tributed in the soil where they can live for almost unlimited periods. 

 Wounds inflicted upon men in the field, especially -by the blunt and 

 ragged projectiles of high explosives, and by any injury passing 

 through' soil and filth covered clothing, through unwashed skin, 

 furnish an ideal nidus for infection. In consequence, in prac- 

 tically all the allied armies every wounded man was given an 

 injection of about 1,000 to 1,500 units of tetanus antitoxin as soon 

 after the injury as he came under medical observation. In civilian 

 life, the wounds that require similar prophylactic treatment are 

 those inflected with much traumatism and under dirty conditions, 

 especially those in which compound fractures are involved. 



We refrain from giving any set rules for prophylactic treatment. 

 The principles involved are that the injection of from 500 to 1,500 

 or even up to 5,000 units should be made subcutaneously as soon 

 as possible after the injury. It should be remembered that the 

 first injection may not be sufficient. The antitoxin gradually dis- 

 appears in the course of about twelve days, and wounds that are 

 slow in cleaning up or cases in which secondary interference, such 

 as removal of sequestrum, resetting of bones, etc. becomes necessary, 

 may call for a second injection after six to eight days, with due 

 precautions to prevent anaphylaxis. In such cases, according to 

 the judgment of the surgeon, second injections should become almost 

 the rule since experience in the war has shown that after two 

 injections tetanus is very rare in appearance. 



Recently, very important advances in our knowledge of tetanus 

 have been made by W. J. Tulloch 38 who in 1917 showed that tetanus 

 bacilli could be classified into at least three and perhaps four types 

 by agglutination with anti-bacterial serum prepared by injection of 

 the bodies of tetanus bacilli. The important point which arises in 

 this connection is, of course, whether the toxins produced by these 

 various agglutinative types differ either qualitatively or quantita- 



38 Tulloch, Journal of the R. A. M. C., Dec. 1917. 



