Page:Wound infections and some new methods for the study of the various factors which come into consideration in their treatment.djvu/14

2 A cultivation medium is now provided by the blood and lymph which are poured out into the track of the projectile; and we find in the wounds—I have in view here wounds examined immediately after arrival from the Front—a mixed infection of a streptococcus with microbes derived from the fæces (fig. 1). This fæcal infection is a special outstanding feature in this war.

Among many species of intestinal microbes which have been found in wounds, two have a quite special importance. One is the gas-phlegmon bacillus, or Bacillus aerogenes capsulatus of Welch—a large Gram-staining, anaerobic and actively gas-forming microbe. It is found both in infiltrated superficial wounds and in deep wounds, and is particularly abundant in the frothy and offensive fæcal-looking discharges which anaerobic wounds furnish. The other is the tetanus bacillus. This is more rarely encountered, and is also much less abundant in the discharges. Sometimes, however, it may show up in every field of the microscope.

The presence of the streptococcus and these two fæcal microbes makes the first period of the wound infection—the period of imprisoned discharges—a specially critical time for the patient. During this the streptococcus may invade the tissues, and set up cellulitis or, more rarely, erysipelas. Or the