There possibly may be microbes infinitesimal to those of microscopic size, and of many varieties, scattered everywhere through the air and through the animal body. To deny that there may be microbes so small that hundreds, and even thousands, may infest an ordinary bacillus, is only to admit that our conceptions are limited by our experience. We cannot deny their existence, and possibly we may never be able to prove it. The larger the telescope the more stars are discovered; the more powerful the microscope the more tiny microbes are discovered. Analogy suggests the existence of such. Chemists claim the existence of corpuscles a thousand times smaller than hydrogen atoms (J. I. Thompson, Cambridge University).

Ordinary bacteria are discovered only by the most skillful opticians, yet they are on and in everything around us. The gaping wound very quickly absorbs them; all fruits and vegetables, and flesh not living, cheese, and butter, and milk, are at once attacked by bacteria of some kind, which continue their ravages till the object attacked is completely dissipated. These bacteria, then, do not generate an antitoxin to themselves. In the case of suppurating wounds, boils and contagions, something antagonizes the devouring microbes, for they usually cease without producing death. In the case of the boil and the wound, it seems unreasonable that the products of the bacteria are destructive to them, for the organisms continue to work and produce pus until the sore is cleared of this pus, then healing comes without any antitoxin administered; perhaps the phagocytes devouring the bacteria, or perhaps some other antimicrobe does the work. If it is the vital force, it is strange that this force is so much stronger after the bacteria have ruined much flesh, than at the beginning, when the bacteria were weak. The theory, to be true, needs no spontaneous generation of antimicrobes, for they can be accounted for in many other ways.

Raveners in all life, whether beast, or bird, or serpent, or fish, or insect, or parasite, vegetal or animal, have some choice in the selection of their prey, and the lower the grade the more specific the choice. The silkworm scarcely preys upon anything else than mulberry leaves; some worms prey on hickory

leaves, others on oak leaves; the tobacco worm exclusively on tobacco leaves, the tobacco fly on the pollen, or honey, of the Jamestown weed, the bagworm rarely on anything else than cedar or arbor vitae, and, I think, there is only one kind of bird that preys on the bagworm. So all devourers have some choice as to their prey. It seems still more the case with microbes. On the other hand, toxins and antitoxins have but little choice, as already shown.

There is nothing vegetal or animal but what is preyed upon by both large and small raveners: bears and fleas prey upon hogs, foxes and mites upon chickens, beetles and microbes upon grasshoppers, cattle and blight upon many fruit trees, birds and bacteria on bees and ants. Then, shall we say that nothing large or small preys upon the microbes of contagion? Are they the only exception, in all biological science, to the law of being a prey, to the law of antagonism?

"Men have fleas on their backs to bite 'em,

And lesser fleas on these ad infinitum.

It seems that every species of organism is subject to disease in some form, in both vegetal and animal kingdom. Blight, rust, smut in wheat, among plants; contagions among bees and Rocky Mountain locusts, among insects, and so on. But it is generally agreed that all contagions, and most of other diseases, are caused by microbes of some kind. Now, if there are no antimicrobes, these microbes of disease, and all other microbes, are an exception to the law. They are the only organisms on which nothing preys; the only organisms not subject to disease. Where there is the antagonism that destroys a contagion whose bacteria are floating everywhere in earth, air and water, can any antitoxin multiply sufficiently to destroy the plague? Antimicrobes having a rich living on their favorite prey, may multiply and grow enormously, amply sufficient to devour all the microbes of the prevailing epidemic.

The phagocytes may keep out of a person any specific antimicrobes till the person is attacked by measles, for instance, then the phagocytes having heavy work, the antimicrobes have an easy task to enter in, and finding a rich pasturage, destroy the measles germs before these germs destroy the perHaving once ensconced themselves in the person they remain, living, perhaps, on the effete matter of the system, harmless to the immune.

son.

TETANUS.*

BY JAMES S. RAWLINS, M.D.

DANCYVILLE, TENN.

I AM induced to report this case for several reasons. First, on account of its prolonged and aggravated character and happy recovery. Second, this disease has rarely been before this association since the discovery of its specific bacillus by Nicolaier and the introduction of the antitoxin treatment, and a discussion of the merits of this as well as other methods of treatment is desirable.

The patient, Anderson Wrenshaw, white, male, aged 10 years, while at play stuck a stick in the dorsum of his foot near the heel. The stick, which was about an inch long, pointed, and as large as an ordinary lead pencil, broke off and was retained in the wound.

On June 27 he applied for treatment, and was found with the usual symptoms of tetanus-stiffness of neck and back, with sardonic features. Upon questioning his father, a highly intelligent clergyman, I found that there had been some stiffness about his neck and back for twenty-four hours or longer, which was regarded as an approaching attack of mumps, other members of his family having recently had the disease, which would make the period of incubation since the reception of wound about six days. With the assistance of Dr. R. B. Davis he was completely anesthetized and a deep incision made through the old wound, which had closed, and the fragment of a retained piece of wood about half an inch long removed. The wound was cleansed, swabbed out with carbolic acid, and dressed with an ethereal solution of iodoform. The patient was ordered to a darkened and absolutely quiet room, and was given to open his bowels 5 grains of calomel and bi-carb. soda each, to be followed by a saline cathartic, or an enema. if it did not act in a reasonable time. There was also ordered 8 grains of hydrate of chloral and 16 grains of bromid of potassium every three hours until quiet or asleep.

On the following morning, June 28, upon visiting him we found that he had passed a restless night, with tonic spasm of muscles of trunk and neck, and was threatened upon the least noise or excitement with general convulsions. Pulse 120, temperature 1011°F.

*Read before Tri-State Med. Assn. (Miss. Ark. & Tenn.) Memphis, Nov. 20, 1901

The wound was again dressed under chloroform, swabbing out the cavity and dressing with iodoform gauze. Treatment continued as before, increasing the chloral hydrate to 10 grs. and the bromid of potassium to 20 grains every three hours, with directions to push the chloral and bromid to hypnotism if necessary to prevent general convulsions, also to have all the concentrated nourishment he could possibly take.

Upon the third day, finding the chloral and bromid insufficient to prevent the spasmodic waves which frequently passed over the patient's body, chloroform by inhalation was used whenever a spasm threatened. While the patient was constantly in a state of opisthotonos, and frequently in an arch resting upon his occiput and heels, he also was frequently subjected to violent clonic spasmodic waves which could be only kept in abeyance or lightened by the inhalation of chloroform, which was kept by his bed and ready for inhalation at all times.

Fourth day, treatment continued as before. Commenced rectal alimentation, on account of inability to take food by the mouth.

Fifth day, nervousness had increased so that the least noise, light or touch would bring on convulsions, axillary temperature 1021°F., pulse 130 to 140, and at times imperceptible.

Sixth day, the patient was showing so much prostration, with pulse so feeble, it was decided to discontinue the chloral and bromid and substitute morphin and atropia, which was given, gr. morphin, atropia, to be repeated every three hours until it produced some narcotism. Under its use the pulse improved, but the atropia producing some hallucinations, had to be given less frequently-every six hours.

On the ninth day of treatment, having procured some antitetanic serum, we used the first dose of 10 cubic centimeters, which was repeated every six hours, until four doses had been given, at the same time continuing the previous treatment.

I will not pursue the treatment of this case from day to day, but the same course of treatment was kept up, chloroform as needed, morphin and atropia as much as could be safely given, persistent alimentation, and catheterism as needed, as he had been unable to void his urine since we commenced the use of morphin.

On the twelfth night of his attack he had a very violent convulsion involving his diaphragm, and but for the presence of Dr. Davis, who resorted to artificial respiration, would, no doubt, have died.

From this time his improvement commenced, which was very gradual, almost imperceptible, chloroform having to be used frequently to prevent spasms, until the sixteenth day of attack. The morphin and atropia was suspended, by gradual reduction, on the twenty-fourth day of attack. He was able to stand on his feet on the thirtieth day, but his muscles, especially those of his legs, were easily startled, and subjected to jerks and spasms for some time after.

For some time he had a bed sore on the back of his head, the result of continued opisthotonos.

The average amount of morphin required, after getting under its influence, was 14 gr. per day. The average amount of chloroform per day, judiciously used, was about 2 oz.

In the treatment of this case we endeavored to carry out the following principles:

1. Isolate the patient.

2. Cleanse the area of infection to prevent the continued absorption of the alkaloidal poisons.

3. Antagonize the poisons that have already been absorbed by the use of injections of antitoxin.

4. Combat the spasms by chloral, morphin and chloroform. 5. Maintain the strength of the patient, and attend to the patient's bladder and bowels.

The value of antitetanic serum not being sufficiently affirmed, as the antitoxin treatment has been in diphtheria, I did not feel disposed to use it, except as a last resort, or as an auxiliary treatment, and did not commence its use as soon as I would again under similar circumstances. In this case, it nothing more can be said for it, it at least was harmless, not even producing an induration at the points of insertion, and while given at a period when the poison, no doubt, had spent itself in the production of organic lesions, still, the father of the patient, an eminent clergyman, who has had a great deal of sick-room experience, is very positive that after the second dose of serum he could perceive a decided improvement, or giving way, as he terms it, of some of the most violent symp

toms.

In the treatment of another case, in addition to the course pursued, recognizing that the disease in its incipiency is a local one, and that the germs do not sporulate even at a moderately