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THE PATHOLOGY OF GAS GANGRENE.
1063 For the moment the wide powers con. ferred upon the Food Controller only concern us. The powers and duties of the Food Controller He is to regulate the supply and are defined. consumption of food in such manner as he thinks best for encouraging the production of food. For these purposes he will have such powers or duties of any Government department or authority, whether conferred by statute or otherwise. By an Order in Council His Majesty may transfer to the Food Controller or authorise him to exercise or perform concurrently with, or in consultation with, the Government department or authority concerned. Further powers may be conferred on him by regulations under the Defence of the Realm Consolidation Act, 1914. and regulations made under that Act The office of Food Controller is accordingly. to cease to exist on the termination of a period of 12 months after the conclusion of the present war or such earlier date as may be fixed by His Majesty in Council. Apparently Lord Devonport’s duties are confined to questions of distribution, the curtailment of supplies, and the encouragement of home production. The question of securing an increase in imported supplies is being left, no doubt, to the Ministry of Shipping, which is asked, amongst other things, to " control and regulate any shipping available for the needs of the country in such manner as to make the best use thereof."
Shipping.
THE
PATHOLOGY OF GAS GANGRENE.
ON Monday afternoon last, at the Royal So ciety of Medicine, Sir Almroth Wright delivered a short
address on the pathology of gas gangrene, in which he described the recent work done by himself and his coadjutors abroad, and by other workers in laboratories at home, the purport of his remarks being to show the relation of laboratory research to clinical experience and procedure. Throughout the lecture the behaviour of the Bacillus perfringens was in particular question, but much, even most, of the teaching had application to bacterial infection in general. The lecturer introduced his subject by saying that while it was necessary to study the behaviour of bacterial infection in the laboratory so as to arrive at the therapeutic courses to be adopted, it must be remembered that laboratory methods might mislead, because wrong emphasis might be laid upon some quite accurate piece of research, whereby a half-truth would become magnified into the whole story. For instance, the gangrene bacillus in ordinary circumstances is an anaerobe, but the statement that it can only grow in the absence of oxygen must be taken with large reservations when other than ordinary conditions prevail. It is now known that this bacillus can grow in air in the presence of animal or vegetable tissue, and this with extreme vigour, wherefore the use of peroxide as a dressing and the opening up of wounds to the air, though, so far as they go, such treatment is founded on laboratory research, are not necessarily efficacious. In considering what other therapeutic measures might be possible Sir Almroth Wright commenced by demonstrating that a local concentration of the bacteria of gas gangrene favourable to a spread of the was extremely infection, for where the bacteria, implanted either in broth or in blood serum, were allowed by
gravitation much more than where
to concentrate themselves, they spread rapidly, and with the production of gas, they were disseminated throughout the
fluid. The first lesson which he drew from this demonstration of "avalanche"infection was that the presence in any wound of crypts, or of foreign bodies whose surface could supply a nidus for bacillary growth, was particularly favourable to a fatal spread of infection. Further laboratory experiments sugthat such a nidus was furnished by the gested recesses of cotton-wool, asbestos, or a rusty nail, just as much as by those of a carrot or a potato, indicating that in the laboratory experiments, where these vegetables had been used, the spread of the growth was not dependent on, or was only in some very indirect and secondary manner assisted by, the essential qualities of the vegetables. Having demonstrated that the anaerobic Bacillus perfringens can and will grow rapidly though air be present, the lecturer passed to the conditions of blood infection produced by the bacillus. Many charts were exhibited setting out the results of experiments proving that the bactericidal power of the blood is very great, but that in blood the same ominous spread follows concentration of the bacilli, and the lecturer suggested that two chemical factors were present when infection by the Bacillus perfringens took place. First, he said, the blood is made less alkaline by the action of microbes, while acidaemia favours their growth. Secondly, the antitryptic power of the blood is minimised by the disorganisation of the white corpuscles, and the destruction of these corpuscles also favours microbic growth; and he mentioned that Captain S. R. Douglas had shown in the Pathological Laboratory of St. Mary’s Hospital that the antitryptic power of the blood being decreased, the spread of infection followed. The teaching arising out of Sir Almroth Wright’s theory, and supported by numerous experiments, was therefore as follows. We have in gas gangrene two conditionsnamely, the process of blood digestion by the bacillus producing acidsemia and the voiding of trypsin by the decomposition of the white corpuscles-whereby the bacillus is enormously assisted in growth ; and all the time any mechanical or chemical assistance to concentration of the bacilli will have the same In conclusion, Sir Almroth deleterious effect. Wright detailed experiments made on rabbits and rats in support of what had started as a laboratory theory, and came to the conclusion that treatment by incisions and irrigation was justified by bacteriological research. In another column there will be found a summary of an interesting paper read before the Section of Surgery of the society by Miss M. H. F. Ivens, M.S., who has been working two years at a French military hospital, the subject being on anaerobic wound infection. In this paper 107 cases of gas gangrene, regarding the flora as multiple and not limited to the Bacillus perfringens, were analysed. It is interesting to note that the factors of importance found in the production of these cases agree very well with Sir Almroth Wright’s views.
for
THE
BACTERIOLOGY OF WHOOPING-COUGH.
THE recent researches of Mme. Chievitz and Dr. A. H. Meyer,1 both of Copenhagen, into the bacteriology of whooping-cough have thrown light upon several important points in the natural history of that disease. It is due, as is well known, to infection by the minute Bacillus pertussis disThis covered in 1906 by Bordet and Gengou. microbe may be cultivated from the sticky muco-purulent expectoration brought up at the Grown on end of the paroxysms of coughing. Annales de l’Institut Pasteur, Paris,
1916,
xxx.,
503.
Shipping.
THE
PATHOLOGY OF GAS GANGRENE.
ON Monday afternoon last, at the Royal So ciety of Medicine, Sir Almroth Wright delivered a short
address on the pathology of gas gangrene, in which he described the recent work done by himself and his coadjutors abroad, and by other workers in laboratories at home, the purport of his remarks being to show the relation of laboratory research to clinical experience and procedure. Throughout the lecture the behaviour of the Bacillus perfringens was in particular question, but much, even most, of the teaching had application to bacterial infection in general. The lecturer introduced his subject by saying that while it was necessary to study the behaviour of bacterial infection in the laboratory so as to arrive at the therapeutic courses to be adopted, it must be remembered that laboratory methods might mislead, because wrong emphasis might be laid upon some quite accurate piece of research, whereby a half-truth would become magnified into the whole story. For instance, the gangrene bacillus in ordinary circumstances is an anaerobe, but the statement that it can only grow in the absence of oxygen must be taken with large reservations when other than ordinary conditions prevail. It is now known that this bacillus can grow in air in the presence of animal or vegetable tissue, and this with extreme vigour, wherefore the use of peroxide as a dressing and the opening up of wounds to the air, though, so far as they go, such treatment is founded on laboratory research, are not necessarily efficacious. In considering what other therapeutic measures might be possible Sir Almroth Wright commenced by demonstrating that a local concentration of the bacteria of gas gangrene favourable to a spread of the was extremely infection, for where the bacteria, implanted either in broth or in blood serum, were allowed by
gravitation much more than where
to concentrate themselves, they spread rapidly, and with the production of gas, they were disseminated throughout the
fluid. The first lesson which he drew from this demonstration of "avalanche"infection was that the presence in any wound of crypts, or of foreign bodies whose surface could supply a nidus for bacillary growth, was particularly favourable to a fatal spread of infection. Further laboratory experiments sugthat such a nidus was furnished by the gested recesses of cotton-wool, asbestos, or a rusty nail, just as much as by those of a carrot or a potato, indicating that in the laboratory experiments, where these vegetables had been used, the spread of the growth was not dependent on, or was only in some very indirect and secondary manner assisted by, the essential qualities of the vegetables. Having demonstrated that the anaerobic Bacillus perfringens can and will grow rapidly though air be present, the lecturer passed to the conditions of blood infection produced by the bacillus. Many charts were exhibited setting out the results of experiments proving that the bactericidal power of the blood is very great, but that in blood the same ominous spread follows concentration of the bacilli, and the lecturer suggested that two chemical factors were present when infection by the Bacillus perfringens took place. First, he said, the blood is made less alkaline by the action of microbes, while acidaemia favours their growth. Secondly, the antitryptic power of the blood is minimised by the disorganisation of the white corpuscles, and the destruction of these corpuscles also favours microbic growth; and he mentioned that Captain S. R. Douglas had shown in the Pathological Laboratory of St. Mary’s Hospital that the antitryptic power of the blood being decreased, the spread of infection followed. The teaching arising out of Sir Almroth Wright’s theory, and supported by numerous experiments, was therefore as follows. We have in gas gangrene two conditionsnamely, the process of blood digestion by the bacillus producing acidsemia and the voiding of trypsin by the decomposition of the white corpuscles-whereby the bacillus is enormously assisted in growth ; and all the time any mechanical or chemical assistance to concentration of the bacilli will have the same In conclusion, Sir Almroth deleterious effect. Wright detailed experiments made on rabbits and rats in support of what had started as a laboratory theory, and came to the conclusion that treatment by incisions and irrigation was justified by bacteriological research. In another column there will be found a summary of an interesting paper read before the Section of Surgery of the society by Miss M. H. F. Ivens, M.S., who has been working two years at a French military hospital, the subject being on anaerobic wound infection. In this paper 107 cases of gas gangrene, regarding the flora as multiple and not limited to the Bacillus perfringens, were analysed. It is interesting to note that the factors of importance found in the production of these cases agree very well with Sir Almroth Wright’s views.
for
THE
BACTERIOLOGY OF WHOOPING-COUGH.
THE recent researches of Mme. Chievitz and Dr. A. H. Meyer,1 both of Copenhagen, into the bacteriology of whooping-cough have thrown light upon several important points in the natural history of that disease. It is due, as is well known, to infection by the minute Bacillus pertussis disThis covered in 1906 by Bordet and Gengou. microbe may be cultivated from the sticky muco-purulent expectoration brought up at the Grown on end of the paroxysms of coughing. Annales de l’Institut Pasteur, Paris,
1916,
xxx.,
503.