TETANUS 151 



have been beneficially modified, largely through the knowledge spread 

 by The Journal of the American Medical Association. The parts of 

 our country most abundantly infected with this virus seem to be the 

 Atlantic States, Long Island and the valley of the Hudson. Commer- 

 cial gelatin and catgut used by surgeons, have been the bearers of 

 this infection and most thorough sterilization is necessary in order 

 to destroy the spores. Formerly, we spoke of idiopathic and traumatic 

 tetanus. Now, we are quite sure that the former does not exist. 

 The wound may be so trivial that it has healed before symptoms of 

 tetanus develop. In other cases the wound may be not on the skin 

 but on a mucous membrane as in the mouth, nose or throat. I saw a 

 case in which the virus had entered through the gum from which a 

 tooth had been extracted. Some have claimed that tetanus is more 

 prevalent in black and mixed races than among whites and have 

 endeavored to show the existence of racial susceptibility. The truth 

 is that filthiness is the predisposing agent rather than a racial difference. 

 The simple custom of drying the wash by spreading the clothes on the 

 ground has been found to play a part in the prevalence of this disease. 



The distribution of the tetanus virus seems to be world wide. It has 

 been found in every land and in many waters, such as those of Lake 

 Geneva and the Dead Sea. It may be present in bilge water and 

 ships may be generally infected. On one English ship, after a naval 

 battle, sixteen of the wounded died of tetanus. It may be carried 

 into wounds with bits of infected clothing, and it has been found on 

 nearly every article worn by soldiers from the shoes to collars. Virgin 

 forest soil has generally been found free from this virus, but the 

 sweepings from the streets, stables, houses, boats and cars frequently 

 produce tetanus when introduced under the skin of animals. 



Of our domestic animals, the horse is the most susceptible and 

 is a frequent victim. The ox comes next on the list, followed closely 

 by sheep and goats. Dogs and cats are not easily infected, but do 

 succumb to inoculations. 



When swallowed the tetanus bacillus has no effect .unless there be 

 some break in the mucous membrane, and it is eliminated with the 

 feces unchanged. In this way the fecal matter of man and animals 

 pollutes the soil. The tetanus bacillus produces a soluble toxin which 

 is one of the most potent poisons known. Injected into an animal, 



