ADVANCES IN SURGERY DURING THE WAR 313 



the success of immediate closure. Added to this was the fact 

 that the soil of the western battle front, in Belgium and North- 

 ern France, had for many generations been intensively culti- 

 vated, and manure and human dejecta had been used for 

 fertilization. As a consequence the soil fought over was richly 

 impregnated with bacteria, especially of the fecal variety, both 

 spore bearing and non-spore bearing. The spore bearing 

 organisms are very tenacious of life and resistant to destruction. 

 Among these fecal organisms the most important and virulent 

 met with in the war were the bacillus tetani, which causes 

 tetanus or " lock-jaw," and the bacillus aerogenes capsulatus 

 (Welch) or perfringens, which causes gaseous gangrene. 

 There are other varieties mixed with these and usually found 

 associated with them in wounds ; but these are the ones which, 

 especially in the earlier stages of the war, caused the greatest 

 mortality in the wounded. The clothing of the soldiers was 

 necessarily more or less fouled with the germ-laden earth; 

 often their skins were dirty, too, for a dainty toilet and ideal 

 cleanliness are not often possible under field conditions; so 

 that when a wound was inflicted these virulent organisms, to- 

 gether with the ordinary pus-producing bacteria, were carried 

 into the depth of the wound either on the projectile itself, or 

 on shreds of clothing or skin which are usually carried into the 

 wound by the projectile, and there they found a favorable home 

 in which to multiply and elaborate their toxins. The "lock- 

 jaw " and " gas gangrene " bacilli are anaerobic, that is, they 

 flourish only when they are protected from the action of 

 oxygen or air; so that deep wounds and those which exhibit 

 pockets or side tracks are the ones which are best suited to the 

 needs of these organisms. Naturally, then, the rational treat- 

 ment of such wounds and the one practiced with success if 

 the patient was seen sufficiently early was either excision of 

 the entire wound, or if such was not possible, the thorough and 

 wide opening up of the wound so that there were no pockets 

 or crevices left which prevented the access of air to them. 

 Due to the high incidence and the fatal effect of tetanus or 



