708 PATHOGENIC MICROORGANISMS 



from all parts of the wound, and absence of hemolytie cocci should be estab- 

 lished by two successive negative cultures before suture is made. It has been 

 observed that streptococci are prone to lie dormant in small numbers, but to 

 flare up and cause virulent infection after closure of the wound." 



In compound fractures the same principles apply, except that, 

 as stated by Pool, expedition, thoroughness and early closure is 

 particularly important because it means the conversion of open into 

 closed fracture. In such fractures of the long bones, delayed 

 primary suture, that is, suture not later than six days after the 

 infliction of the wound, should be aimed at. He states that it lias 

 been demonstrated repeatedly that severe' fractures of long bones, 

 except the femur, may be closed in from three to six days after 

 debridement. If this cannot be done, secondary suture may often 

 be made successfully under proper bacteriological control. 



In the case of joints, the principle of treatment consists in com- 

 plete debridement of the tract of the wound into the soft parts and 

 bone, with the removal of foreign bodies and irrigation of the joint, 

 followed by absolute closure of the joint by suture, with or without 

 closure of the superficial parts. 



If a joint becomes distended after the operation and infection 

 is suspected, the effusion should be aspirated and examined by smear 

 and culture. If such examination indicates infection, the joint 

 should be reopened and treatment for suppurative arthritis begun. 



In civil surgery the principles worked out with war wounds 

 can be applied with still greater hope of success, since here the 

 nature of the trauma and infection is apt to be less extensive. 



As to serological treatment in civilian surgery, this will be 

 applicable chiefly in cases in which there has been a considerable 

 delay in the proper surgical treatment of the wound after its inflic- 

 tion. It seems most probable at the present time that the most 

 hopeful prospect for future therapy will lie in the combination of 

 antitoxic sera against B. Welchii, B. oedematiens and Vibrion Sep- 

 tique, with Tetanus antitoxin, prophylactically injected in the same 

 way in which Tetanus antitoxin alone has been used, hitherto. 

 Whether it will be possible to produce this in polyvalent sera pro- 

 duced in the same horse or whether they will have to be separately 

 injected, will depend upon future investigation in large scale serum 

 production. 



Bacillus of Symptomatic Anthrax (Bacillus anthracis symp- 

 tomatici, Rauschbrand, Ckarbon symptomatique, Sarcophysematos 



