296 IMMUNOLOGY 



Summary of Important Factors Relative to Gas Gangrene. — 



Some of the important facts that have been established by clini- 

 cal and experimental investigations of gas gangrene may be sum- 

 marized as follows: 



1. There are three of these anaerobes, i.e., CI. welcMi, CI. 

 septicum and CI. oedematiens, that are regarded as the most impor- 

 tant ones in gas gangrene. There is at the present time a poly- 

 valent antitoxin capable of neutralizing all three toxins avail- 

 able conmiercially. 



2. Incubation Periods for Various Toxins. — When the toxin of 

 either CI. welchii or CI. septicum is injected in sufficient 

 amounts intravenously into rabbits, death occurs within five to 

 fifteen minutes. In other words, there is no incubation period fol- 

 lowing the intravenous injection of adequate doses of these toxins. 

 On the other hand, the toxin of CI. ocdematiens never kills acutely 

 but only after a recognizable incubation period. Zinsser and 

 Bayne- Jones (1939) state that when 0.01 c.c. of a potent toxin of 

 this organism is injected intravenously into a 300 or 400 gram 

 guinea pig, death results within forty-eight hours. When lethal 

 doses of these respective organisms are injected into the thigh 

 muscles of guinea pigs, there is an incubation period of several 

 hours in each case. CI. welcMi produces deatli within twenty-four 

 to sixty hours, CI. septicum within twelve to twenty-four 

 hours, and CI. oedcnuitiens within twenty-four to forty-eight hours. 

 Kettle (1919) states tliat the absence of a cellular response such as 

 is seen in pyogenic infections is characteristic of the lesions due to 

 these anaerobes. While there is not a collection of phagocytic cells 

 in the muscle tissue, he says there may be a few neutrophiles in 

 the subcutaneous and connective tissue. 



3. Tetanus in Wounds. — Spores of CI. tctani not infrequently 

 gain entrance to wounds in the same material that contains spores 

 of the anaerobes responsible for gas gangrene. It is, therefore, 

 advisable to administer tetanus antitoxin simultaneously with 

 the polyvalent antitoxin for the latter organisms. 



4. Tissues Affected. — Gas gangrene was regarded at one time 

 as a disease of muscle tissue only, but it has since been found that 

 the toxins are not specific for muscle but act on other tissues as 

 well. Gas gangrene of the abdominal wall following major oper- 

 ations has been reported by Orr (1934) and others. 



