Bacteriology of Septic War Wounds. 271 



difficult to obtain sufficiently thin sections to allow of magnification 

 X 1000. 



To enable the exact spot chosen by myself to be found and 

 photographed, recourse was had to the Maltwood finder. Two 

 of these were kept in use. 



For general purposes of comparison, and to facilitate reference, 

 an album is kept of the silver-prints of the negatives, each print 

 receiving the index-number and letter of the case corresponding to 

 the serial card on which the records are kept in the bacteriological 

 laboratory, the material also being cross-indexed. 



General Methods of Investigation. 



"Wherever possible a radiograph of the wound is obtained as 

 soon as possible after injury, and at appropriate intervals during 

 its history. For these radiographs I wish to tender my thanks 

 to my colleague. Dr. Berry, Eadiologist to the Eoyal Herbert 

 Hospital, Woolwich. 



Cultivations, pus-films, and tissue-films were made as soon as 

 practicable after the admission of the patient, the various species 

 of aerobic and anaerobic bacteria plated out and examined. A 

 similar procedure was carried out at any operation on the case, and, 

 in addition, histological examination made of tlie tissues removed 

 for identification of actual bacteria in situ, as well as the tissue 

 reaction to the injury. By these methods it has been found possible 

 to obtain a fairly complete history of the wound, including (1) 

 general damage as seen by the naked eye; (2) the bacterial 

 content of the wound ; (3) the predominant bacterial infection in 

 the superficial and deep parts of the wound ; (4) the special 

 tissue-changes caused by different species of bacteria ; and (5) an 

 evaluation of appropriate methods of treatment for the prevention 

 of generalized infection, and the most rapid methods of obtaining a 

 cure. 



In many instances it has been possible to follow up individual 

 cases, to watch bone-changes through the medium of radiographs, 

 and to correlate these changes with the predominant bacterial flora ; 

 if, and when, a sequestrum formed and was removed, a careful 

 bacterial analysis was made of the wound before and after the 

 removal of the sequestrum. 



Anaerobic bacteria were constantly found, especially in the 

 sequestra removed at long intervals after the original wounding, 

 and as this particular class of bacteria are met with in most war 

 wounds, special forms of apparatus are required for feheir isolation 

 and study. 



