The Washington herald., 1908-06-22

Believing that neglect OF proper pre-
cautions against tetanus in dressing
wounds resulting from the celebration OF
the Fourth OF July is responsible for
many Of the deaths which follow the holl-
day, Surgeon General Wyman, OF the
Marine Hospital Service. will to-day send
out general warning in the Public
Health Report
In the last i've years there have been
7SS cases OF tetanus as the result of the
annual Fourth Of July celebration. Of
which 72l have died, n mortality Of % per
cent. Six hundred and eight or 50 per
cent Of the cases resulted from blank
cartridge wounds. The number OF cases
resulting from blank cartridge wounds
has steadily decreased from 1853 in 1903 10
% in 1907. but the cases following other
wounds have not nuctuated.
This warrants the belief that while
wounds from blank cartridges are prop
erly cared for. other hurts are not sclen-
tihcally treated. The cartridges lead in
the number OF cases Of tetanus follow
Ing July with COS in the last five years.
Giant crackers come next with Il. while
cannon crackers are credited with H.
firearms 20, and powder co.
Prepared the Warning.
The warning. which was prepared by
Passed Assistant Surgeon John f. Ander-
son, gives the following explanation Of
the origin and operation Of the tetanus
bacillus:
"The bacillus OF tetanus, or its spore
form, is found in earth. especially gar
den earth. stable manure, the dust OF
the streets, stables, and human habita-
tions. The feces Of healthy animals.
such as the horse, COW, dog, and even
man, may contain tetanus spores.
When tetanus spc-es are introduced
under the skin. they at once germinate.
If oxygen IS excluded. and begin TO elab-
crate tetanus toxin. In a short time IL
appears In the blood, which carries It
to all parts Of the body. where It IS alb
sorbed by the motor nerve-endings which
are bathed In the toxin-laden fluid. The
nerves supplying the jaws. especially the
masseteric, seem TO have an exaggerated
affinity for the poison. which explains
the early trismus
The affinity OF the nerves for the tox-
In and its subsequent binding by them
explains why tetanus antl-toxln is OF
little value after the symptoms have ap-
peared AnttoXin can, however, neu-
traiize any new toxin that may be form
cd In cases In which the focus has not
been removed
Physicians often treat blank cartridge
and other Fourth OF July injuries. unless
Of serious character. as trivial" saws
T. Waning. "contenting themselves with
picking out the plainly seen pieces Of
wad powder. &c. and applying dress
Ing. In few days the patient returns
with symptoms Of tetanus. and then.
when IL Is too late. antitoxin is given
the wound Is thoroughly cleaned out and
perhaps piece Of wad or clothing found
in Il.
II should be an invariable procedure
that al Fourth of July wounds be laid
fully open under local or. preferably. gen
eral anaesthesia. and all foreign material
and necrouc or badly injured tissue re-
moved. as the presence Of blood clots
and necrouc tissue favor anaerobic CON
diuons. which are essential for the de-
Nelopment OF the tetanus organism.
After the wound has been thoroughly
cleaned out, It should be swabbed out
with strong carboIc acid. at least % per
cent Followed by a washing with % per
cent alcohol 10 prevent further action
OF the acid. Some surgeons use peroxide
OF hydrogen instead OF carbouc acid.
AFTER couterization, by whatever meth
Cd used. the wound should be thoroughly
washed out with a 1:1.OOO or 1900 solu-
uu of bicnlorlde Of mercury and packed
with gauze soaked IN a saturated solution
OF sa.icylic or boric acid and a large wet
dressing Of the same solution applied. In
no case should the wound be closed. but
1t should be allowed 70 heal by granuls-
ton. The dressing and packing should
be renewed every day."
Treatment of Wounds.
The following treatment. for Fourth of
July injuries is suggested:
'Incise freely every wound.
Carefully and thoroughly remove from
the wound every particle OF foreign mat
ter.
"Cauterize the wound thoroughly with
p per cent carbolic acid
Apply loosely a wet pack Of 25 per
cent carbolic acid
Give fun dose Of antltetanic serum"