Oxygen in Gas Bacillus Infections

COMMENT AND CORRESPONDENCE to everyone, and gas could be felt above the wound. The tissues were opened, freely on each side .of the ankle and each side of the tendo achiIlis, Editor, THE AMERICAN JOUHNAL OF SUR- tubes for Dakin's solution were introduced GERY, into every available place and the solution was In the October number of THE A:WER- injected every half hour. Hydrogen peroxide ICAN JOURNAL OF· SURGERY I read with was also used freely, but th e redness a nd swelling kept creeping up the leg and the patient pleasure and profit the a rt icle on Gas Bacilwas profoundl y septic. Yet his temperature lus Infection by Dr. I. M. Gage of New was only about 101°. Orleans. also the editorial comment by On October 2, 1926 I had a tank of oxygen yourself on this subject. In neither is there brought to his bed, with a rubber tube and a mention of the use of pure oxygen gas infil- long smaIl hypodermic needle attached. The trated directly into the involved and sur- needle's caliber was smaIl so that when the rounding tissues. May I report briefly a gas was turned on the volume escaping was recent case where I used this treatment? I not great. I first infiltrated the tissues of the would like to know whether pure oxygen leg with oxygen weIl above th e scat of redness, gas has been used in this country as I have all around the bones, into the muscles, trying used it, with what results, and whether to load the tissues with the gas. After putting the needle deep into the tissues 1 withdrew there is any objection to its use? it a little hoping thus to avoid blowing the gas int o a blood vessel. Then I infiltrated the t issues Earl H., aged 43, mining engineer, was towards and all about the wound, putting the injured September 2 T, 1926 at StanciardviIIc, needle in many, many time s. I could fecI the Utah by a cave-in in a mine. He entered gas going along under the skin. The patient the Holy Cross Hospital at Salt Lake City, did not complain very much about the treatSeptember 22, 1926. He was generally bruised ment. He said it caused " only a little pain." over his body. He had a crushing fracture of Th is gas was used during the morning hours, the body of the 4th lumbar vertebra with some perhaps 10 A .M. About 6 F.M. the patient had a involvement of the nerves to the' legs. He also moderate chiIl, but from th en on he improved had a compound complicated fracture of his rapidl y. The next morning, 24 hours after right ankle. The tissues were badly lacerated, oxygen was used, the redness of the skin and and the ankle joint was open. This wound was nearly all the swelling were gone. Some of my carefully dressed, dirt and part of his sock were colleagues who saw this case before and after removed from the wound, particles of dead said it was remarkable. The wound healed tissue were cut away and tincture of iodine very rapidly, the patient soon was free from was applied. A plaster of Paris cast was applied septic symptoms, and on November, 18, 1926 I to the leg above and to the foot below the did a Hibbs fusion operation on th e lumbar injury, and a wire cage was made by incor- vertebrae. He is now doing weIl except he may porating the ends of 7.4:-inch gauge wire into the have some trouble with his legs because of plaster above and below the wound so the his cord injury. ankle was immobilized and caged. Two points: rst, the x-ra y picture shows The wound did not behave well, the patient was very ill. The redness and swelling extended . gas in the tissues early; and ·znd, pure The odor was suggesti ve of gas infection. It was not until September 28, 1926 that the oxygen gas freely infiltrated into the laboratory reported positively bacillus welcbii. involved tissue appeared to completely Several days before this an x-ray film showed cure this case with one treatment. several dark areas which Dr. Kerb y, rocntTo me it appears logical that if Welch genolgist, reported were due to gas in the bacilli do not live when in oxygen, to kill tissues. These dark area s were very apparent them pure oxygen gas infiltrated into the

OXYGEN IN GAS BACILLUS INFECTIONS

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A meric an J ou rn a l of Sur gery

Comment and Correspondence

tissues where they are is good treatment. However, I am not familiar with the literature on this subject. ANDREW J. HOSMER, M.D.

DI:CF MBF. R , 1926

be substituted for it after the infection has been overcome.e-W, M. B.

SALT LAKE CITY,

I . DELBET : Bull. de Soc. de Chir, Vol. 41, p. 1324. 2 . VE;-lNIN, GIRODE and HALLEIt: Presse Medicale, Aug. 30. 19 2 5.

November 16, 1926

3.

Various agents have been suggested in the chemotherapy of gangrene. Hydrogen peroxide and potassium permanganate were advocated on the principle that by their oxidative powers they might tend to check the disease . We have seen both fail to do this. Delbet.' showed experimentally that the gas bacillus grew better on muscle tissue previously treated with hydrogen peroxide than on muscle not so treated. Vermin, Girode and Haller" advised injections of oxygen, which Thiriar! of Brussels had described for pyogenic infections in 1899. This, too, proved ineffectual and was later abandoned. Recently, Roantree! of Elko, Nev., unfamiliar with this previous work, recommended the subcutaneous injection of oxygen by a special apparatus. Dr. Hosmer's method was adequate and, certainly, his result was excellent. Sir Almroth Wright proposed the use of hypertonic saline solution dressings. The results were no better than those obtained by the use of other chemical agents. Dakin's solution appears to have a marked proteolytic effect and is vcry effectual in cleansing the wound of debris. As a specific against the anaerobic bacteria, it seems to be of but little consequence. Taylor" showed that a 1 per cent solution of quinine hydrochloride exerted a marked bactericidal effect on the gas bacillus in vitro and suggested the use of this drug in wound dressings. James Pilcher and others appear to have had good results with this chemical. Pilcher's quino-forrnal mixture" was described in Gage's article in the JOURNAL. Instilled into the wound in the same manner as Dakin's solution, it is said to have a very powerful effect on the gasproducing organisms. It has the disadvantage of not being proteolytic and, therefore, Pilcher advises that Dakin's solution

4.

THiRIAR, JULES:

1899· ROANTREE, R .

May

I,

Bull. Acad. roy. de med. de belgique,

P.: Jour. Am. Med. Assn.• Vol. 86,

1926.

,. TAYLOR. KEN N ETH: Lancet. Sept. 4.1915. PILCHER. JAMES TAFT: Ann. Surg.• Vol.

6.

81. Jan.•

1925.

INGUINAL HERNIOPLASTY Editor, THE AMERICAN JOURNAL OF SURGERY,

Your excellent editorial on The Rationale of Surgical Measures for the Cure of Oblique Inguinal Hernia (the JOURNAL, March, 1926) is most timely and interesting. I agree with you that Bassini's hernioplasty is not intended to restore the inguinal canal to an anatomic normal condition, as you so clearly point out. Many writers who report poor results with this operation fail to carry out the technical details set forth in Bassini's original paper, published in 1889. Even at that early date he was able to point out the pitfalls of hernia surgery just as they are today, and his methods of overcoming them have been improved upon but little. Anyone doing hernioplasty can afford to carefully peruse this early monograph. The most important points, in my opinion, are : A painstaking stripping of all unnecessary tissue from the cord, well up into the internal ring; and the careful suturing of the internal ring (transversus fascia) high up behind the cord, so as to make a snug closure and increase the obliquity of the canal. Marcy so often emphasized the point that the object of a hernioplasty is to increase the length and obliquity of the inguinal canal. I am convinced that the internal obliquus muscle will unite to Poupart's ligament if the areolar tissue is carefully removed from.both structures, and if the