738 PATHOGENIC MICROORGANISMS 



lively. Subsequent investigations by Tulloch 39 showed that of a 

 large number of isolations from infections on the Western Front, 

 his type I organisms were the most frequent, type II and type III 

 next, and type IV the least common. It seemed, in these investiga- 

 tions, that the agglutinin titer of an antitoxic serum is no index to 

 its antitoxic value; the agglutinating sera, even when of very high 

 titer, does not bring out group reactions, but maintains a sharp 

 separation of the types and that the types remain true even after 

 prolonged cultivation. The types could be demonstrated by opsonic 

 as well as by agglutination experiments. Most important is the 

 observation that the spasm-producing toxin is not specific to the 

 types, although there may be quantitative differences in toxin 

 production. Tulloch 's investigations suggest that anti-bacterial 

 properties in tetanus sera, if polyvalent, would aid considerably in 

 the phagocytosis of the organisms, and, therefore, have a prophy- 

 lactic and therapeutic value. His work, also, seems to indicate that 

 small amounts of the tetanospasmin do not locally aid the growth 

 of the tetanus bacillus to any considerable extent, an observation 

 in distinct contrast with the earlier work on this subject. However, 

 B. Welchii toxin and, to a smaller extent, that of Vibrion Septique, 

 considerably aid the growth of tetanus, by, as he expresses it, 

 "devitalizing" the tissues. This leads Tulloch to favor a procedure, 

 advised by other observers on purely bacteriological grounds, 

 namely the combining of antitoxins against the poisons of B. Welchii 

 and of Vibrion Septique with Tetanus antitoxin, in the prophylactic 

 treatment of war wounds. 



Even when this is done, however, he cautions against any feeling 

 of false security which might lead to the neglect of surgical prophy- 

 laxis. 



He emphasizes the great importance of early excision of the 

 wound area. No particular dressings seem to make a great deal 

 of difference, but thorough excision seems to have considerable influ- 

 ence on the development of tetanus and on the mortality. 



The Treatment of Developed Tetanus. To speak of the specific 

 treatment of tetanus without saying a few words about the surgical 

 treatment would be taking the risk of conveying a false impression. 

 Therefore, though our business here is concerned largely with specific 

 treatment, we wish to emphasize that surgical treatment must al- 



89 Tulloch, Journal of Hygiene, vol. 18, 1919, p. 103. 



