766 PATHOGENIC MICROORGANISMS 



will show the surgeon by a giance* the numerical progress of the 

 baeterial infection. 



Carrel states that it is useless to take any smears as long as 

 hemorrhage exists. If the wound is being irrigated with Dakin's 

 solution or other antiseptic fluids, the treatment must be omitted 

 for at least two hours before the smears are taken. Smears taken 

 from the surface of smooth muscles are practically useless, since 

 smooth muscle becomes sterile early in the healing process. There- 

 fore, the choosing of the point of smear is of the utmost importance. 

 The depth of the wound may begin to become sterile at times when 

 individual little foci around necrotic bone, small pockets, etc., may 

 still contain numerous bacteria. This must be borne in mind and 

 an intelligent survey of the wound made by the bacteriologist who 

 takes the smear. To overlook such dangerous points would seriously 

 imperil the life of the patient, were the wound closed. When 

 absolutely no bacteria are found in such smears, it does not mean 

 that the wound is completely sterile. It is still possible that cultures 

 might reveal organisms, and when the period of secondary closure 

 approaches, especially when streptococci have been present at a 

 previous time, we would regard it of the greatest importance to 

 take a culture aimed particularly at the demonstration of hemolytic 

 streptococci, before the actual suture is carried out. 



Cultural examinations should be made at the beginning by taking 

 specimens from parts of the wound selected as indicated above, 

 and smearing them upon fresh blood-agar plates (without glucose). 

 This is primarily aimed at determining whether cocci, and especially 

 hemolytic streptococci or staphylococci, are present. If the smears 

 show a great many bacilli resembling the ordinary anaerobes, it 

 may be well, too, to make anaerobic cultures, but anaerobic analysis 

 is not of great immediate value to the surgeon as far as further 

 procedure is concerned because of the long time consumed by such 

 examinations. Suture is not carried out if hemolytic cocci of any 

 kind are present, and for this season, with a smear as a preliminary 

 indication, frequent culture upon blood plates should be undertaken 

 during the progress of the treatment. 



In discussing the subject, it is not possible to give an intelligent 

 survey of the bacteriological methods, without, to some extent, 

 entering into the surgical considerations involved. For this reason 

 .we quote from Pool, 31 whose experience with this type of wound 

 has been extensive. 



Pool, E. H., Jour, A. M, A., 73, 1919. 



