TETANUS r. Infective Agent.—Bacillus tetani.
2. Source of Infection.—Herbivorous animals, particularly horses and mules.
3. Portals of Exit.—The feces of such animals, rarely the dis charge from infected wounds.
4. Route of Transmission.—Animal manure and objects and soil contaminated with animal manure. The spores of the organisms are very resistant and can survive for indefinite periods outside the body. Hence fomites transmission occurs.
5. Portal of Entrance.—Subcutaneous introduction of spores into wounds, cuts and abrasions, usually through their con tamination with soil or manure, hair, etc.
6. Incubation Period.—Six to fourteen days, usually nine.
7. Period of Communicability.—The patient is not a source of infection, except in rare cases where the wound discharges are infective. On the other hand, same horses are chronic carriers.
8. Methods of Control. The Infected Individual.—(a) Diag nosis: Clinical manifestations which may sometimes be con firmed bacteriologically.
(b) Isolation: None.
(c) Immunization: Passive protection, secured by the ad ministration of antitoxin, should be employed. The antitoxin has given the best results as a prophylactic agent. As a result of recent military experience the folllwing rules should be fol lowed in its administration: • 1. Every wounded person should receive at least 500 units prophylactically. This dose should be repeated on the 7th and 14th days thereafter.
2. Repeat the doses at more frequent intervals if there is any reason to fear tetanus.
3. Repeat injections forty eight hours prior to any secondary operation.
4. If tetanic manifestations develope, the subcutaneous and intramuscular routes of injection are preferable. Daily doses
of at least Io,000 units should be given and continued well into convalescence. The injections should be given at different depths and at several points in the muscle tissue on the injured side, if an operation is contemplated.
The importance of early prophylactic doses is indicated by the following results in 65 cases of tetanus: (a) Antitoxin administered within 24 hrs. of wounding: 43 cases, each receiving 500 units; 62.7 per cent. fatal, 37.2 per cent. recovered.
(b) Antitoxin administered after 24 hrs. of wounding: 23 cases, each receiving soo units; 86.9 per cent. fatal, 13.1 per cent. recovered..
(d) Quarantine: None.
(e) Concurrent Disinfection: None.
(f) Terminal Disinfection: None.
General Measures (Especially to PreventW ound Contamination).
(a) Supervision of the practice of obstetrics, so that proper care is given to the care of the infant's cord (Trismus neonatorum).
(b) Educational propaganda, along the lines of the "safety first" campaigns and "Safe and Sane" Fourth of July campaigns.
(c) Prophylactic use of tetanus antitoxin when wounds have been acquired in regions where the soil is known to be heavily contaminated with manure, and in all cases whose wounds are ragged and penetrating.
(d) Removal of all foreign matter from wounds as early as possible.
(e) Governmental supervision of biological products, so that only potent antitoxin is distributed.