Pathogenesis 383 



sematous. The birds usually die in from seven to twenty- 

 four hours, but may recover. 



Intraperitoneal inoculation of animals sometimes causes 

 fatal purulent peritonitis. 



Sources of Infection. The infection seen in man usually 

 occurs from wounds into which earth has been ground, 

 as in the case of a compound, comminuted fracture of the 

 humerus, with fatal infection, reported by Dunham, or in 

 wounds and injuries in the neighborhood of the perineum. 



Among the twenty-three cases reported by Welch and 

 Flexner * we find wounds of the knee, leg, hip, and forearm, 

 ulcer of the stomach, typhoid ulcerations of the intestine, 

 strangulated hernia with operation, gastric and duodenal 

 ulcer, perineal section, and aneurysm, as conditions in which 

 external or gastro-intestinal infection occurred. 



Dobbin, f P. Ernst, { Graham, Stewart and Bald win, and 

 Kronig and Menge|| have studied cases of puerperal sepsis 

 and sepsis following abortion either caused by the bacillus, 

 or in which it played an important role. 



Williams ** has found the bacillus in a case of suppura- 

 tive pyelitis. 



The symptoms following infection are quite uniform, con- 

 sisting of redness and swelling of the wound, with rapid 

 elevation of temperature and rapid pulse. The wound usu- 

 ally becomes more or less emphysematous, and discharges a 

 thin, dirty, brownish, offensive fluid that contains gas bubbles 

 and is sometimes frothy. The patients occasionally recover, 

 especially when the infected part can be amputated, but 

 death is the common outcome. After death the body begins 

 to swell almost immediately and may attain twice its normal 

 size and be unrecognizable. Upon palpation a peculiar crep- 

 itation can be felt in the subcutaneous tissue nearly every- 

 where, and the presence of gas in the blood-vessels is easy of 

 demonstration. The gas is inflammable, and as the bubbles 

 ignite explosive sounds are heard. 



At the autopsy the gas bubbles are found in most of the 

 internal organs, sometimes so numerously as to justify the 



* "Journal of Experimental Medicine," vol. I, No. 1, Jan., 1896. 



t"Bull. Johns Hopkins Hospital/' Feb., 1897, No. 71, p. 24. 



J "Virchow's Archiv," Bd. cxxxm, Heft 2. 



"Columbus Med. Jour.," Aug., 1893. 



|| " Bakteriologie des weiblichen Genitalkanals," Leipzig, 1897. 



** "Bull. Johns Hopkins Hospital," April, 1896, p. 66. 



