THE FIGHT AGAINST GAS-GANGRENE

Dominion, Volume 11, Issue 54, 27 November 1917, Page 6

THE FIGHT AGAINST GAS-GANGRENE

HOW SCIENCE IS WINNING

OPEN-AIR TREATMENT 'FOR

WOUNDS

(By Woods Hutchinson, M.D., iu the "Daily Mail.") Ike gas-gangrene of this present war is a tar less serious disease than the ok hospital gangrene. It has one great redeeming feature by contrast—that is, it is not actively contagious or inclined 0 spread. This is probably becauso our modern surgical measures have, boon able to bar out tho pus-forming germs and prevent them from forming that wicked partnership" with the gasJaeillus which gave its infection wings, so to speak, in the old hospital gangrene. As wo had no anti-toxin against it wo were driven to hunt for other 1 weapons.

His first hold which we got on tho I germs came from the fact that they 1 are what nre known as auerobic—that I is to say, can live without air; and | not only that, but are killed by, or grow very slowly in, the presence of air mill oxyguii. This lining thp porc, itwas quite evident that our modern aseptic method of closing and sewing up all wounds tightly and at the earliest nossible moment was giving the bacillus the very thing that, he most wanted—airlessness and warmth. Consequently it became the rule to leave all shell wound l ; of any considerable depth, or of pocketed, irregular shape, or with mouths much smaller than their deeper parts, as wide open as possible for the first three to five days. This at once diminished- tho number of our eases of gas-gangrene. The next step was the discovrv tint, as the bacillus could not "eat" or live upon living tissue, if Ave could manage to clean and cut away and scrape out ibn wound the crushed and shattered fragments of flesh whose vitality was destroyed, we should deprive the germs of any food to live upon or material to grow on. _ When this was thoroughly done within four or five hours—or in circumstances where it was necessary, within thirty-six hours of receiving the wound —our eases of gas-gangrene took another and much heavier dron. In fact, these two methods of "ventilation" and thorough cleaning have already brought it down to less than a tenth of its former prevalence. Finallv, it n-as found that while the gas-bacillus, when looked for my micro•scopio methods, would he found in twothirds, or even three-fourths, of all the wounds in a given hospital, and even though some of the cases had not heen able to "et this oarlv thorough cleaning out of tho wounds, the vast majority of them all would escape any serious gas infection. And, what was the important point, most of those who did develop even a moderate degree of gas infection were cases in which somo snccial cause of depression was at work. They had had severe haemorrhages and lost a lot of Mood, or they had fallen in No Man's Land or in a shell-cratcr during a great battle, and had to lie out in the inud and rain, or even snow, for six to twenty '.hours before they could be brought in and attended to, or they had been ill or in poor condition from, some cause before they were wounded. 111 short, nil conditions which tended to lower the vitality of the wounded man or which lowered the vitality of the tissues in his wound, by lack of timely and prompt attention, increased the probability of a gas infection. The first and second of these preventive steps—namely, the thorough ' cleaning out of all dead or dying tissue in tho wound, technically known as debridement—are steps in the now famous and magnificently successful Carrel treatment, and wherever that is introduced gas-gangrene sinks almost to tho vanishing point, though, unfortunately, not quite.

Furthermore, as tho medical service on the Western fronts has become so perfectly and magnificently organised,, and particularly as spur lines of rail-' road and trolley lines have been used for transportation of the wounded, these distressing delays and the enforced neglect of cases have practically disappeared, and cases of gas-gangrene have gone down jn like proportion. Incidentally it may be said that there seoms sometimes a curious confusion in the mind between gasgangrene and gas poisoning from gas attacks. lioth are among the blessings of tvar, but other than that have not the slightest connection. I have even seen it gravely stated that gas-gan-grene is the result of the gas of gas clouds or attacks getting into wounds! Vile and abominable as gas clouds and gas shells are, and heavy the disgrace —and, we hope, punishment—of the German brutes who invented them and forced their use in war, their: gas, chlorine, has no injurious effect upon wounds, even if it happen to be blown into them.

* On the contrary, though irritating it would be distinctly antiseptic. In fact, hy most singular coincidence, this very gas, chlorine, dissolved in water, is the active antiseptic principle of the Dakin solution used in the Carrel treatment.