348 Tetanus 



dous, else so few bacilli growing under adverse conditions could not 

 produce fatal toxemia. The toxin is produced rapidly, for Kitasato 

 found that if mice were inoculated at the root of the tail, and the skin 

 and the subcutaneous tissues around the inoculation afterward 

 either excised or burned out, the treatment would not save the ani- 

 mal unless the operation were performed within an hour after the, 

 inoculation. 



Some incline to the view that the toxin is a ferment, and the 

 experiments of Nocard* might be adduced in support of the theory. 

 He says: "Take three sheep with normal tails, and insert under the 

 skin at the end of each tail a splinter of wood covered with the dried 

 spores of the tetanus bacillus ; watch these animals carefully for the 

 first symptoms of tetanus, then amputate the tails of two of them 20 

 cm. above the point of inoculation, . . . the three animals succumb 

 to the disease without showing any sensible difference." 



The circulating blood of diseased animals is fatal when injected 

 into susceptible animals because of the toxin it contains; and the 

 fact that the urine is also toxic to mice proves that the toxin is ex- 

 creted by the kidneys. 



Two classes of infected wounds are particularly apt to be followed 

 by tetanus — namely, those into which soil has been carried by the 

 injuring implement and those of considerable depth. The infecting 

 organism reaches the first class in large numbers, but finds itself 

 under aerobic and other inappropriate conditions of growth. It 

 reaches the second class in smaller numbers, but finds the conditions 

 of growth better because of the depth of the wound. 



The severity of the wound has nothing whatever to do with the 

 occurrence of tetanus, pin-pricks, nail punctures, insect stings, 

 vaccination, and a variety of other mild injuries sometimes being 

 followed by it. 



An interesting fact has been presented by Vaillard and Rouget,t 

 who found that if the tetanus spores were introduced into the body 

 freed from their poison, they were unable to produce the disease 

 because of the promptness with which the phagocytes took them up. 

 If, however, the toxin was not removed, or if the body-cells were 

 injured by the simultaneous introduction of lactic acid or other 

 chemic agent, the spores would immediately develop into bacilli, 

 begin to manifacture toxin, and produce the disease. This suggests 

 that many wounds may be infected by the tetanus bacillus though 

 the surrounding conditions rarely enable it to develop satisfactorily 

 and produce enough toxin to cause disease. 



In very rare cases tetanus may possibly occur without the pre- 

 vious existence of a wound, as in the case reported by Kamen, who 

 found the intestine of a person dead of the disease rich in Bacillus 

 tetani. Kamen is of the opinion that the bacilli can grow in the 



* Quoted before the Academie de Medicine, Oct. 22, 1895. 



t See " Centralbl. f . Bakt. Infekt., u. Parasitenk.," vol. xvi, p. 208. 



