764 PATHOGENIC MICROORGANISMS 



is not directly concerned with the question of bacteriological control, 

 a matter which is desirable and seems eminently logical whatever 

 method the surgeon chooses to use for the disinfection of the wound. 

 It is, however, chiefly in connection with Dakin's solution irrigation 

 that this method was developed by Carrel. The most complete 

 treatise on the entire matter may be found in the book lay Carrel 

 and De Helly, "The Treatment of Infected Wounds," (Hocber, 

 New York, 1919). 



The usual type of war wound or, for that matter, any kind of 

 traumatic wound, presents conditions in regard to the possibilities 

 of infection which are quite different from those ordinarily en- 

 countered in aseptic surgery. From the skin and clothing bacteria, 

 both aerobic and anaerobic, are carried by the projectiles or other 

 foreign bodies into the tissues. Tissues are destroyed to a variable 

 degree, and such devitalized tissues furnish an excellent medium 

 for bacterial growth. There is always an interval or latent period 

 between contamination of the wound and proliferation and penetra- 

 tion of the organisms. The duration of this latent period varies, 

 but usually approximates six hours. 



The immediate aim of treatment is the prevention or limitation 

 of infection, and, for this reason, the rational method of determining 

 whether this purpose is being accomplished and what the next 

 procedure should be is bacteriological control. 



The first step in limiting infection in such wounds is accom- 

 plished by debridement, that is, excision of the tract with removal 

 of all the devitalized and contaminated tissues, together with foreign 

 bodies, bits of projectile, clothing, etc. Bacteria are greatly 

 diminished though not eradicated by this procedure. 



Bacteriological control of the original infection of the wound and 

 its progress under treatment is carried out by a method of systematic 

 smear examination of the wound, supplemented by cultures, first 

 practically developed by Carrel. 



The smear method, introduced by Carrel and employed since that 

 time by many surgeons on a large material, is simple, can be carried 

 out by any well trained assistant or technician without the aid of a 

 highly trained bacteriologist, and has apparently yielded results of 

 value. Our description is taken almost entirely from Carrel 's own writ- 

 ings. "Wounds should be examined every two or three days, and when 

 the time for secondary closure appears, perhaps every day. The 

 principle consists in the examination of the secretions of the wounds 



