Page:Wound infections and some new methods for the study of the various factors which come into consideration in their treatment.djvu/17

Rh tetanus bacillus may find opportunity to grow out and manufacture its poison and induce tetanus. Or the bacillus of Welch may make its way into the body and set up a gas-phlegmon in the region round about the wound, and an obstructive gangrene in the distal portion of the limb. Or, again, the bacillus of Welch and the streptococcus may join forces, and may in conjunction produce the gas-phlegmon or cellulitis.

As soon as a free outlet has been provided, and aerobic conditions have been established in the wound, its bacterial flora changes. The ordinary pyogenic infection, which has up to this been in abeyance, now gains the upper hand, and instead of an "infection of the imprisoned discharges," or, as the case may be, an infection of tissues, we have now an "infection of the granulating wound surfaces, and of the flowing discharges." The chief bacterial agents here at work are the streptococcus and staphylococcus, and Bacillus proteus (fig. 2).

This pyogenic infection may, after lapse of time, subside the wound healing up when this occurs; or the mixed infection may narrow itself down to a streptococcic infection and become chronic, the wound in this case remaining open indefinitely in the form of a discharging sinus. Or, lastly, when