March 9, 1917] The Treatment of War Wounds 



41 



In Fig. 9 I show you what happens when we make into the blood 

 a very heavy implantation of the gangrene l)acillns. Here in the 

 neighbourhood of the leucocytic layer things are for the moment 

 going well for the leucocytes, for they are actively phagocyting. 

 But farther away from that layer there are very numerous colonies of 

 the gangrene bacillus, which are growing unimpeded. The omens 

 are consequently unfavourable. You can see in your mind's eye 

 what is going to happen. In the first place, all further emigration 

 of leucocytes is going to ])c arrested. And, in the second place, the 



Fig. 9. 



-Leucocytes emigrating and attacking colonies of 

 the gas gangrene bacillus. 



leucocytes which have already emigrated and ingested microbes will, 

 instead of successfully digesting them, be gradually poisoned by 

 bacterial toxins. And when the leucocytes are killed, their digestive 

 ferment — trypsin — passes out into the serum. By that, the serum 

 will, as we have seen, be converted into a medium in which microbes 

 can grow and pullulate. 



Distinction between "Live" and "Dead" Spaces. 



But we must now come back from these general questions to that 

 of the treatment of the wound. Let me begin by explaining to you 

 — for important questions of treatment hinge apon this — the dis- 

 tinction between " Jive s^paces " and " dead spaces'' 



