Waterbury evening Democrat., 1904-06-30


 of causing the disease are quite char acteristic and of the utmost import ance ill considering curative measures. Of the more common infections, diph- theria presents the closest analogy to tetanus, in that in both the bacteria remain quite strictly localized and cause harm by producing soluble poi sons that are absorbed into the circu- lation. It is extremely seldom that the tetanus bacillus enters the blood or reaches remote organs; this has been recorded in the literature but five times and so 1t becomes possible to stop the progress of the infection by removing the infected tissue Further more, there are few, if any, fatal in fectious diseases in which the number of bacteria is so small, for 1t is often difficult to demonstrate them with the microscope ill the wound secretions or the tissues. Tetanus is then, of all dis eases characterized by a strictly local ized infection, and an intoxication with diffusible poison.
 1t goes without saying that the most desirable way to put an end to all this source of mortality is to prevent the wounds that begin the trouble. Aboli- tion of blank cartridges and giant crackers would have reduced the num- Der of deaths last year to less than twenty, and this is probably true of all other years. Display fireworks, such as Roman candles and rockets, caused but few tetanus infections, and so far as we could learn there were none from paper caps, torpedoes and the small fFecrackers. Surely these harmless forms of explosives ought to be suffi- cient for the entertainment of the children and for installing patriotism Of at least equal value with the toy pis- tol and the cannon cracker. The work that physicians can do In their commtl- mites to lessen such evils Of the Fourth is by no means inconsiderable, but having recently discussed the mat l ter editorialy we shall limit ourselves here to discussing what can be done to prevent tetanus following such wounds as will be received this Fourth, As by far the most important wounds In regard to tetanus, and the most ire | quent are those produced by blank l cartridges, these are entitled to partic- ular consideration.
 l Blank cartride wounds form as de- l captive a class as can be imagined. 1 Usually they present simply rather c1ean-cut perforation in the skin, about which are embedded many pow der grains, for the wound is usually produced with the muzzle of the pistol but few inches away from the skin. l This is not serious appearing wound, and if the boys parents are not famil- lar with the danger he runs from te- tanus they are likely to think that a simple dressing is all that he needs. And even if he is taken to physician, I too often the same opinion Is express ed. History of several Fourths has shown that very large proportion of the cases have occurred in boys who were seen by physician soon after they were injured, and whose treat ment had consisted solely in the appli- cation of wet or dry dressing, or per haps at the best a more or less inef- fective attempt had been made to re- move the wads. It is impossible, in the face of what we know about these wounds and their dangers, not to feel that many of these cases of tetanus would have been prevented by proper care of the injury when it was re ceived.
 The nature of the blank cartridge wound is primarily explosive. The chief damage is done beneath the skin, and the distance to which the injury extends is almost unbelievable unless one is familiar with these injuries. The force of the explosion follows particu- larly along the tendon sheaths and fas- cia when the wound is in the hand, as 1t usually is, and is by no means un- common for powder and dirt entering the wound of the finger to be found near the wrist, driven there along the tendon sheaths. The size of the chan nel formed by the explosion is usually smallest near the skin, and enlarges for some distance into the deeper tts'
 sue until the wads are reached, and
 there spreads laterally in mass of
 bruised and lacerated tissue, blacken
 ed by fire and powder. The penetra'
 tive power of the wads is not generally
 appreciated. but 1t is well illustrated
 by case reported by Allen of boy
 who shot himself in the abdomen with
 blank cartridge, and the wad mol
 only perforated the wall of the abdo
 men and entered the peritoneal cavity but so damaged the bowel that fata, peritonitis resulted. When the wounC is ill the palm of the hand, one of the coInmonest sites, the wad may pass between the metacarpal bones and eff fleets of the explosion will nearly al ways be found beneath the skin of the dorsum of the hand.
 The surgical treatment of the wound must, therefore, be most thorough 1 Merely opening the wound and picking
 out the wads, even if followed by drainage, is evidently inadequate; anc if we take into account the tetanus spores, even in the best tube, are not killed by per cent of carbolic acid 1T ten hours, it is evident that no amount of washing of the wound with antisep
 tics will assure safety from tetanns in
 lection. Safety demands that every
 part into which dirt from the surface
 can have been blown be cleaned out
 and so packed that air can enter ano
 wound secretions escape. This re
 duires anesthesia and careful dissec'
 ton. The greatest difficulty in most
 cases will probably lie in the objections of the parents of the boy, and this must be met with instruction as to the dan | o,ors ond +ha necessities of the Sftua,