Bacteriology of Septic War Wounds. 275 



limb is tense, crackles on pressure, and if the limb is incised a 

 rush of gas takes place which, if lit with a match, lights with 

 explosive violence. Such cases are rapidly fatal. In other cases 

 the development of gas is delayed for many days, and then only 

 appears slowly and insiduously ; while in yet a third type of 

 case the actual anaerobic bacilli which cause the gas may be 

 found without any symptoms of gas gangrene appearing. Much 

 of my attention has been directed to the elucidation of the causes 

 underlying the development of this fell disease, and I have 

 published the results * of an inquiry into this question, and have 

 arrived at the conclusion that, in the cases which develop gas 

 gangrene several days after wounding, there is a symbiosis with 

 certain aerobic bacteria whose activities prepare the way for the 

 microbes of gas gangrene by digesting tlie tissues and creating a 

 fertile soil for their growth. 



The radiograph of the actual limb from which my next illustra- 

 tion was taken showed a foreign body (a fragment of shrapnel) on 

 the inner side of the tibia. Stretching from the foreign body was 

 seen a long line of gas-infiltrated tissue. The slide (fig. 8) 

 shows a section of a portion of this gas-infiltrated tissue with the 

 muscle fibres widely separated. Tlie case died suddenly from 

 heart failure. Masses of organisms, B. perfringens and the aerobic 

 B. lactis cvrogenes, were obtained from the incised tissue both at 

 operation and at the post-mortem. 



Figs. 6 and 7, PI. XIX, are from another similar case, in which 

 acute gas gangrene occurred in both leg and arm ; one, showing 

 the organisms, was stained by Gram method, the other shows the 

 cells in which the organisms were situated, and was stained by 

 hsematoxylin-eosin, which stain does not show the bacteria. This 

 case also died of acute general toxaemia. 



Figs. 9 and 10, PI. XX, illustrate another case of gas gangrene, 

 occurring in the shoulder-joint after severe injury. The pus-film 

 shows the heavy infection (fig. 9, PI. XX). Fig. 18, PI. XXI, is a 

 culture of B. cedematis maiigni obtained from the case. Fig. 10, 

 PI. XX, is a portion of the tissue removed at operation, in which 

 numerous organisms are scattered throughout the degenerating 

 tissue. This man has made an excellent recovery. He was 

 treated with vaccine immediately after admission, and the anti- 

 sepsis vaccine continued for eight weeks. 



Fig. 11, PL XX, is the muscle tissue of another case of gas 

 gangrene, in which a foreign body (shrapnel fragment) was sur- 

 rounded by an area of gas gangrene. 



A previous illustration (fig. 6, PI. XIX) also demonstrates that 

 the body tissues under some circumstances attack and destroy 



* The Lancet, July 15, 1916, Sept. 30, 1916, and Nov. 18, 1916 ; Proc, Roy. Sec. 

 Med., X. No. 2. Dec. 1916. 



