Wounds of Men ivho received Prophylactic Inoculation. 531 



importance that a census should be made of the various tetanus bacilli 

 recovered from cases of the disease. Such an investigation would give an 

 indication as to whether in man a monotypical serum gives adequate protec- 

 tion against all Types. If — either in a qualitative or quantitative sense — 

 such protection were specific, the preponderance of cases among inoculated 

 men should prove to be due to infection with heterologoiis Types. 



The first series of 14 toxic cultures investigated by the agglutination 

 technique were all obtained from wounds of men who had received serum 

 prophylaxis. 



The methods used in the examination of this series are fully dealt with 

 in previous publications, but the results may be summarised as follows : — 



Twelve of the 14 cultures examined reacted in the presence of one or other 

 of the Type agglutinating sera; 2 proved to be Type I, 7 Type II, and 3 Type III. 

 One of the two remaining cultures was found, on further purification, to 

 contain Type II, but the other could not be placed. It is probable, in the 

 latter case, that the number of tetanus bacilli in the culture was small, for 

 when mice and rats were injected with as much as 0'5 'cub. cm. doses of 

 a 4-day culture, only local tetanus developed, and that four days after 

 inoculation. 



Agglutinating sera, prepared by the inoculation of non-toxic end-sporing 

 bacilli (some of which closely resemble B. tetani), failed to agglutinate 

 relatively pure toxic cultures. Further, the type sera failed to flocculate 

 cultures of non-toxic end-sporing bacilli. 



A second series of investigations were then undertaken, and strains from 

 100 cases of declared tetanus occurring among wounded men have been 

 successfully examined by the agglutination technique. During this inquiry 

 a fourth type of B. tetani appeared, but it has only been found to occur in 

 four cases of the disease. 



The distribution of the types in this series is given in Table I. 



Table I. — Distribution of Types in cases of Declared Tetanus. 



Number. 



Type. 



Percentage. 



■11 



i 



41 



22 



11 



22 



33 



III 



33 



4 



IV 



■A 



The actual incidence and death-rate percentage from each " type infec- 

 tion " is graphically shown in fig. 1, 



2 u 2 



