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Arch Surg. 1920;1(3):407-427. doi:10.1001/archsurg.1920.01110030002001.
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I. PATHOGENESIS OF TETANUS  The following propositions may be accepted as proved:1A. The Nature of the Disease.—The disease is a pure toxemia; the bacilli or their spores may exist indefinitely in the tissues, and no symptoms will be produced unless toxins are formed.It is important to realize, as pointed out by Tulloch,2 that at least three different strains of toxic B. tetani are recognized, and more than one nontoxic strain. And one must not forget the necessity for symbiosis of the spores of tetanus bacilli (and even of the bacilli themselves) with certain other organisms before a toxin can be produced. Tulloch3 found B. welchii and Vibrion septique very valuable in experimental work; while the simultaneous presence in the wound of the pyogenic organisms has long been appreciated as a predisposing factor of the greatest importance.B. Tetanus Ascendens.—In experimental tetanus, when small


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