514 



NATURE 



[August 23, 191 7 



THE TREATMENT OF WAR WOUNDS.^ 



WE are wont to classify the patients in our military 

 hospitals into sick and wounded. In reality all, 

 -or nearly all, are suffering from bacterial infections. 

 And the essential difference between the sick 

 and the wounded lies in this, that the sick 

 are suffering from infections spontaneously 

 contracted, the wounded from infections induced 

 by mechanical injuries. My theme is the treatment of 

 this latter class of infections. They are distinguished 

 by certain quite special features. 



In spontaneous infection we have to deal with 

 microbes which have fought their way into the body, 

 and generally only a single species of microbe will 

 have done this. In wounds we have microbes mechan- 

 ically driven in, and every sort of microbe which exists 

 in external Nature may thus be introduced. 



But let me, before embarking upon the question of 

 .their treatment, first tell you something about the 



•J'FiG. I. — Method of pyo-sero-culture. A, Pipette which has been 

 implanted by the wet-wall metnod, and has then been filled in 

 by the wash and afcer-wash procedure with unit-volumes of 

 serum. By the side of the pipette to the right is ranged a 

 series of drops representing the series of unit-volumes of serum 

 blown out in order from the pipette, and, finally, to the right of 

 the drops is a series of hnes representing linear implantations 

 made upon agar. B, Results of the series of linear implantations 

 made with the unit-volumes of the patient's serum. C, Results 

 of the series of linear implantations made with the unit volumes 

 of the normal serum which was used as a control. 



.natural agencies by which the inroads of microbes are 

 combated. You are, of course, aware that we are 

 guarded against microbic infection by our blood fluids 

 and our white blood corpuscles. 



The Body Fluids. 



Let me begin with the blood fluids, and let me take 

 you directly to the following experiment. I call it the 

 experiment of pyo-sero-culture — i.e. the experiment in 

 which we implant pus into serum to see which of the 

 microbes of the wound can grow in the blood fluids. 



We • procure for our experiment a suppurating 

 wound. We take from it a specimen of pus contain- 

 ing a large variety of different organisms. At the 

 same time we take from the patient's finger a sample 



1 By Sir Almrolh E. Wright, C.B., F.R.S. In its original form this 

 lecture was delivered at the Koyal Institution on March 9. It was supple- 

 mented by additional matter relating to antiseptics and the method of Carrel, 

 and was printed in full in the Lancet o{ June 23. Parts of the lecture of 

 purely technical interest have been omitted. 



NO. 2495, VOL. 99] 



of blood ; and we take a specimen also of our own. 

 When the serum has issued from the clot we take a 

 capillary pipette, fit a rubber teat to the barrel, and 

 inscribe a mark upon the stem at about, say, one-third 

 of an inch from the tip. We now aspirate a little pus 

 into the stem, drawing it up only so far as our fiducial 

 mark, and, blowing it out again, leave a wash of pus 

 upon the walls. This done, we sterilise the tip of the 

 pipette, and then aspirate into the stem a series of unit- 

 volumes of serum, dividing each volume off from the 

 next by a bubble of air. The pipette when filled in 

 this manner presents the appearance shown in Fig. i, 

 and we have in the proximal end our first and heaviest 

 implantation of pus, and in the distal end our last and 

 lightest implantation. The pipette is now placed in the 

 incubator to allow every microbe 

 which is capable of growing in serum 

 to do so. After an interval of six 

 or more hours we proceed to our 

 examination. What we do is to blow 

 out our series of unit-volumes of 

 serum in separate drops and examine 

 under the microscope ; or, better, we 

 pl.int out a sample of each drop upon 

 a separate seed-bed. Here in B and 

 C you have the results of such cul- 

 ture represented diagrammatically — 

 the meagre crop in B being that ob- 

 tained with the patient's serum, and 

 the more copious crop in C being that 

 obtained with normal serum. 



And you have in the next figure 

 (Fig. 2) a drawing of an agar tube 

 implanted from a pyo-sero-culture 

 made with the serum of a wounded 

 man. In the upper part of the agar 

 tube you see two seed-plots implanted 

 from the distal portion of the capil- 

 lary stem. These have remained 

 sterile. In the middle of the tube 

 you see four plots implanted from the 

 unit-volumes of serum which occu- 

 pied the middle region of the capil- 

 lary stem. These have grown colonies 

 of only one species of microbe — the 

 streptococcus. At the bottom of the 

 tube you see seed-plots implanted 

 from the proximal end of the capil- 

 lary stem. These are overgrown with 

 colonies of staphylococcus. But no 

 doubt interspersed with, and over- 

 grown by, these are also colonies of 

 streptococci. If, instead of cultures 

 from the patient's serum, I had been 

 showing you here cultures from 

 normal serum, what you would have 

 seen would have been a much larger 

 number of fertile seed-plots, and 

 the seed-plots implanted from the 

 proximal end of the pipette would have shown a large 

 assortment of different colonies. 



We learn from such experiments three lessons : first, 

 that in the uncorrupted serum in the distal region ot 

 the pipette only two species of microbes from the 

 wound can grow and multiply; secondly, that in the 

 corrupted serum in the proximal end of the pipette all 

 the microbes <)f the wound can grow; and, thirdly, 

 we learn from a comparison of the wounded man's 

 serum with the normal serum that the former offers 

 more resistance to microbic Growth, and is less easily 

 corrupted by the addition of pus. 



Cause of the Corruption of the Serum. 

 Experiments of this kind clearly do not tell us the 

 cause of the corruption of the serum. That corruption 



Fig, 



2. — A portion of 

 a pyo-sero-culture 

 planted out upon an 

 agar slant divided 

 up by furrows into a 

 series of seed-beds. 



