BACILLUS TETANI 105 



in the presence of oxygen (anaerobic), so that a secluded 

 place in the depths of wounds favors their development and 

 that of their toxin. Simple uncomplicated, open wounds 

 are probably never the site of development for tetanus 

 bacilli. If other germs are introduced the tissues are further 

 devitalized by them, and they absorb any available free 

 oxygen, so that favorable conditions for tetanus are increased. 

 Either spores or vegetating germs may be introduced on 

 rusty nails, splinters of wood or glass, blank- cartridge plugs, 

 the grinding of dirt into wounds or by introduction of dirt 

 or soiled clothing in shell wounds. Tetanus sometimes 

 appears in the newborn or in the puerperal mother, particu- 

 larly after instrumental delivery. Ordinary gelatin, some- 

 times injected under the skin to arrest hemorrhage, is said 

 to often contain spores. 



Between the time of introduction of the germs and the 

 outbreak of symptoms a period of incubation elapses which 

 may be as short as three days or as long as six weeks. The 

 muscles nearest the wound are affected first, as a rule, but 

 the characteristic symptoms of lockjaw soon appear. After 

 death very little is to be found by postmortem. 



The danger from patients with tetanus is quite inconsider- 

 able, the only infective material being the discharges from 

 the wound or the pieces cut away surgically. Such objects 

 are used for injection into animals to establish a diagnosis. 

 This, however, is seldom necessary, as tetanus is quite clear 

 in its symptomatology. All dressings and pieces removed 

 surgically must be burned with actual fire. Boiling and 

 baking are unreliable. The first treatment usually under- 

 taken is the surgical cutting away of skin and subcutaneous 

 tissue far beyond the original wound, in order to remove all 

 bacilli. If these are removed no more toxin can be made. 



The tetanus bacillus is large, faToU to ^oVo mcn l n g DV 

 50000 to 30000 inch wide; it is a motile, spore-bearing 

 bacillus, growing only when the atmospheric oxygen is shut 

 out. The motility is due to flagella arranged all about the 



