So definite is the connection between the tetanus bacilli and the soil, that tetanus fields or lockjaw gardens are now recognized and listed by the health authorities, on account of their having given rise to several successive cases of the disease. Workers in such fields or gardens, who scratch or cut themselves, are warned to report themselves promptly for treatment with the tetanus antitoxin.
Apart from the tetanus germ, however, the problem of the treatment of wounds—while there should be perfect cleanliness, the spotlessness of the model housekeeper multiplied fivefold—is yet not so much a matter of keeping dirt in general out of the wound, as of keeping out that particular form of dirt which consists of or contains, discharges from some previous wound, sore, ulcer, or boil!
While both these pus-organisms can breed and flourish freely only in wounds or sores, this is but their starting-point where they gather strength to invade the entire organism. We used to make a distinction between those cases in which their toxins or poison-products got into the blood, with the production of fever, headache, backache, delirium, sweats, etc., which we term septicæmia, and other cases in which the cocci themselves were carried into the blood and swept all over the body by forming fresh foci, or breeding-places, which resulted in abscesses all over the body, which we call pyæmia. But now we know that there is no hard and fast line to be drawn, and that the germs get into the blood much more easily than we supposed; and the degree and dangerousness of the fever which they set up depend, first, upon their virulence, or poisonousness, and, second, upon the resisting power of the patient at the time. Anything which lowers the general health and strength and weakens the resisting power of the body will make it much easier for pus-germs to get an entrance into it, and overwhelm it; so that, after prolonged famines for instance, or among the population of besieged cities, or in armies or exploring expeditions which have been deprived of food and exposed to great hardship, the merest scratch will fester and inflame, and give rise to a serious and even fatal attack of blood-poisoning, erysipelas, hospital gangrene, etc. Famines and sieges in fact are not infrequently followed by positive epidemics of blood-poisoning, often in exceedingly severe and fatal forms.
It was long ago noted by the chroniclers that the death-rate from wound-fever among the soldiers of a defeated army was apt to be much greater than among those of the victorious one, and this was quoted as one of the stock evidences of the influence of mind over body. But we now know that armies are not beaten without some physical cause, that the defeated soldiers are apt to be in poorer physical condition to begin with; that they have often been cut off from their base of supplies, have made desperate forced marches without food or shelter in the course of their retreat; and, until within comparatively recent years, were never half so well treated or well fed as their captors.
As the invading germs pass into the body, they travel most commonly through the lymph-channels and skin; are arrested and threatened with destruction by the so-called lymphatic glands, or lymph-nodes. This is why, if you have a festering wound or boil on your hand or wrist, the "kernels" or lymph-nodes up in your armpit will swell and become painful. If the lymph-nodes can conquer the germs and eat them up, the swelling goes down and the pain disappears. But if the germs, on the other hand, succeed in poisoning and killing the cells of the body, these latter melt down and turn to pus, and we get what we call a "secondary abscess."
The next commonest point of attack of these pus-germs, if they once get into the body, and by far the most dangerous, is the heart, as in rheumatism and other fevers. Some will also attack the kidneys, giving rise to albumin in the urine, while others attack the membranes of the joints (synovia) and cause suppuration of one or more joints in the body, which is very apt to be followed by very serious stiffening or crippling. So that, common, and, in many instances, comparatively mild as they are, the pus-germs in the aggregate are responsible for a very large amount of damage to the human body.
This is the way the streptococcus and staphylococcus behave in an open wound, or sore; but they have two other methods of operating which are somewhat special and peculiar. One of these is where the germ digs and burrows, as it were, underground, in a limited space, resulting in that charming product known as a boil, or a carbuncle. The other, where it spreads rapidly over the surface just under the skin, after the fashion of the prairie fire, producing erysipelas. In the first of these he behaves like the famous burrowing owl of our Western plains, who forms, with the prairie-dog, the so-called "happy family." He never makes his own burrow, he simply uses one which is already provided for him by nature, and that is the little close-fitting pouch surrounding the root of a hair. Whether the criminal is a harmless native white coccus which has suddenly developed anti-social tendencies, or a Mongolian immigrant who has been accidentally introduced, is still an open question. The probabilities are that it is more frequently the latter, as, while boils are absolutely no respecters, either of persons or places, and may rear their horrid heads in every possible region of the human form divine, yet they display a very decided tendency to appear most frequently in regions like the back of the neck, the wrist, the hips, and the nose. One thing that these areas have in common is that they are liable to a considerable amount of chafing and scratching as by collars and stocks on the neck, and cuffs on the wrists, or of friction from belts, or pressure or chafing from chairs or saddles. When the tissues have been bruised or chafed after such fashion, especially if the surface of the skin has been at the same time broken, and any pus-organism is either present in the hair-follicle, like the white coccus, or rubbed into it by a finger or finger-nail which has just been sucked in the mouth, used to pick the nose, or possibly engaged in dressing some wound, or cutting meat, or handling fertilizer, then all the materials for an explosion are at hand.