Memorandum on tetanus / issued by the War Office Committee for the Study of Tetanus.

Date:
1919
Catalogue details

Licence: Public Domain Mark

Credit: Memorandum on tetanus / issued by the War Office Committee for the Study of Tetanus. Source: Wellcome Collection.

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    Thus in 100 wounds subjected to immediate excision, 30 contained end-sporing bacteria, while in 100 non-excised wounds, 60 con- tained these anerobes, 30 against 60 per cent. The tetanus bacillus has been especially sought for in wounds of men showing no clinical signs of tetanus ; in 30 excised wounds virulent tetanus bacilli were demonstrated but once (33 per cent.), while in 70 non-excised wounds they were found 18 times (25°8 per cent.). Cases of tetanus are reported with incubation periods of many months, and exemplify latent tetanus infection. Symbiosis between zerobic and anzerobic bacteria is apparently of great importance in the initial stages of tetanus, gas-gangrene and other wound diseases, the growth of erobic bacteria in damaged tissue promoting the development of anzrobic organisms. Se- questra removed from wound areas three or four years after wound- ing have been found to contain end-sporing anerobic bacteria ; the majority of these sequestra show unaltered bony structure and were evidently detached at the time of the original injury. They are commonest in wound tissue which has been the seat of pro- longed sepsis. Histological examination of these sequestra points to their origin from compact bone. The Haversian canals are frequently blocked with a coagulum containing entangled bacteria. Cultivations from the sinus leading to these sequestra often give zerobic cocci only, although the sequestrum and the granulation tissue removed from its bed give abundant anzrobic growth. Metal fragments and bullets removed from completely healed wounds are by no means always sterile but in many instances give anerobic growths. The surgical prevention of tetanus, therefore, consists of the free removal of all damaged tissues before the organisms carried into the wound have developed to a dangerous degree. This will probably be within the first twelve hours of wounding. In excising the wound area care should be taken that no incision is carried from infected wound tissue into surrounding healthy tissue, and instruments used to manipulate wound surfaces super- ficial and deep, should not be used on the surrounding healthy tissue ; clean cutting with a knife is better than scissors as less likely to leave bruised tissue behind. All metal fragments and other foreign bodies should be removed and careful search made for detached bone fragments, including those driven into the sur- rounding soft parts. The removal of large fragments must always be at the discretion of the surgeon, but it may be pointed out that the life of a fragment will partially depend upon the length of the period the fragment has been subjected to suppuration. Instances are on record of local tetanus which bas persisted until a sequestrum was removed or exfoliated. In local tetanus the removal of sequestra or foreign bodies in the vicinity of the wound disclosed by radiograms should be performed as routine treatment but only after a prophylactic injection of antitetanic serum. When removing the foreign body the fibrous capsule enclosing it should also be dissected away. (B 14298) a2