274 Transactions of the Society. 



tissue infection is unfortunately only too common. Fig. 4, PI. XIX, 

 shows this tissue infection. The piece of muscle and bone from 

 which this slide was made was obtained from a case of fracture of 

 both bones of the forearm, and was removed a considerable time 

 (many weeks) after the original injury. The mass of invading 

 organisms is seen to consist of many types, among which are cocci 

 and bacilli resembling B. perfringens. As the body tissues 

 gradually overcome the infecting bacteria, the protective reaction 

 of the tissues changes to one of repair, and loose fibrous tissue 

 gradually repairs the deficiencies in the muscles and binds the 

 whole injured part together, often in mal-position. In this fibrous 

 meshwork (fig. 5, PL XIX) I have frequently found little pockets of 

 bacteria entrenched in the new tissues, unable to grow and do any 

 damage while they are locked up by the stroma woven around them, 

 but nevertheless remaining like seeds in a state of suspended 

 animation until some accident tears their prison walls — such, for 

 instance, as massage, passive movements to a joint, or a subsequent 

 operation — then they take on a new lease of life, and secondary 

 suppuration supervenes. 



My next series are slides illustrating gas gangrene. 



Gas gangrene is a complication wliich may occur with dramatic 

 suddenness in a wound, usually a severe shell wound, and is caused 

 by arf enormous and rapid development of certain anaerobic 

 bacteria, which ferment the natural sugar (inosit and glycogen) 

 always present in muscles with the formation of large quantities 

 of gas. The gas formed blows up the tissues in all directions, 

 and certain poisons manufactured by the bacteria at the same time 

 poison and destroy the vitality of the part. So rapid is the disease 

 in some cases that in a very few hours after wounding the whole 



EXPLANATION OF PLATE XX. 



Fig. 8. — Transverse section of nauscle in gas gangrene. The wide separation of 

 the muscle bundles is caused by distention with gas ; in the inter- 

 spaces numerous organisms may be seen. Stained Gram, x 250. 



„ 9.— Pus-film from previous case, made at the time of operation, showing 

 multiple infection of the original wound ; spore-forming organisms of 

 the clostridial type are seen. Stained Gram, x 1000. 



,, 10. — Tissue removed at operation for spreading septic infection. The tissue 

 structure has disappeared, but a mass of bacteria is seen attached to 

 the walls of the small blood-vessel. Stained Gram-V/eigert. x 1000. 



„ 11. — Muscle section, showing infiltration with spore-forming anaerobes of the 

 B. cedematis maligni type between muscle bundles and progressive 

 digestion of muscle tissue. Stained Gram, x 1000. 



„ 12. — Pus-film in later stages of healing gangrenous wound, showing activity 

 of leucocytes ; streptococci are present undergoing phagocytosis. 

 X 1000. 



,, 13. — Pus-film from similar case at a later stage, showing almost complete 

 digestion of organisms in the interior of the leucocytes. The organisms 

 have now lost their original shape, and are represented by small 

 irregular black dots. Stained Gram, x 1000. 



