Pathogenesis 609 



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 

 German term "Schaumorgane" (frothy-organs). The liver 

 is especially apt to show this condition. When such tissues 

 are hardened and examined microscopically, the bubbles 

 appear as spaces in the tissue, their borders lined with large 

 numbers of the bacillus. There are also clumps of bacilli 

 without gas bubbles, but surrounded by tissue, whose 

 nuclei show a disposition to fragment or disappear, and 

 whose cells and fibers show signs of disintegration and 

 fatty change. In discussing these changes Ernst concluded 

 that they were ante-mortem and due to the irritation caused 

 by the bacillus. The gas-production he regards as post- 

 mortem. 



In the internal organs the bacillus is usually found in pure 

 culture, but in the wound it is usually mixed with other bac- 

 teria. On this account it is difficult to estimate just how 

 much of the damage before death depends upon the activity 

 of the gas bacillus. That gas-production after death has 

 nothing to do with pathogenesis during life is shown by 

 injecting into the ear- vein of a rabbit a liquid culture of the 

 gas bacillus, permitting about five minutes' time for the dis- 

 tribution of the bacilli throughout the circulation, and then 

 killing the rabbit. In a few hours the rabbit will swell and 

 its organs and tissues be riddled with the gas bubbles. 



At times, however, as in a case of Graham, Stewart and 

 Baldwin, there is no doubt but that the bacillus produces 

 gas in the tissues of the body during life. These observers, 

 in a case of abortion with subsequent infection, found the 

 patient "emphysema to us from the top of her head to the 

 soles of her feet" several hours before death. 



In this case, in which the bacillus was found in pure culture, 

 it would indeed be difficult to doubt that the fatal issue was 

 due to Bacillus aerogenes capsulatus. 

 39 



