BACILLUS WELCHII INFECTION AND INTOXICATION
Journal of the American Medical Association
upright bar may either be adjusted tightly so as to prevent mobility of the crutch with the forward and backward movement of the body,. or fixed loosely so as to allow for such motion. (The latter seems preferable-note dotted lines F, P, Fig. 1 ). A belt (Fig. 1 G) fastened to the aluminum Plate buckles around the waist ; and straps extending from "'is plate over the opposite shoulder (Fig. 2 A) give additional security and comfort. A strip of adhesive tape 3 inches wide is placed round a pad
... laced round a pad (Fig. 2 B ) over the arm Oil tile injured side just below the axilla, the free end extending back under the opposite axilla and to the sternum in front. With this apparatus we arc enabled to meet all the requirements known as cardinal principles in treatment of fracture of the clavicle, namely, bringing the arm upward, outward and backward: (1) upward by means of the crutch resting <m the hip; (2) outward by means of the pneumatic cushion m the axilla acting as a fulcrum, and (3) backward by the Use of the adhesive strap around the arm and fastened to 'Inback.' Fig, 3.-Front view of patient with straps adjusted. Fig. -t. -Fracture crutch trapped to patient. ADVANTAGES OF THE CRUTCH SrLINT 1. Most important of all, it is comfortable, and free from the almost intolerable suffering caused by other dressings. 2. It can be used in many cases in which the Sayre or Velpeau dressings cannot be applied. 3. It can be used innumerable times. 4. It can be adjusted to any adult physique. 5. It is inexpensive. 6. It is easily applied and cannot be worked out of place by the patient as are the Sayre and Velpeau dressings, on account of their discomfort. 7. There is no chafing of the skin, the parts are open to inspection, and the apparatus can be easily removed and the injured parts massaged. 8. It allows free use of the forearm and hand. 9. It applies the proper mechanics, meets all the cardinal requirements, and affords perfect immobilization. The problem of gaseous gangrene in connection with shot and shell wounds has been only partially solved by improvements made in the antiseptic treatment of wounds. The essential nature of Bacillus welchii infection has not been established, and this lack of a certain basis of knowledge has hampered progress. Whether the bacilli are mere saprophytic concomitants of an infectious process induced and maintained by other pathogenic micro-organisms, as is held by Weinberg and S\l=e'\guin, or whether tissue destruction is due to a mechanical action of the gas formed, as is held by Kenneth Taylor, or whether they possess invasive powers of their own, as others believe, has not been definitely settled. The indications are, however, that the bacilli tend not to invade the general blood stream and hence do not produce a septicemia to which the severe effects often noted in gas bacillus infection may be ascribed. It would appear, therefore, that a form of poisoning from local action of the bacilli arises ; but it has yet to be shown that the bacilli of Welch are toxin-producing bacteria. We have been able to establish this point. By cultivating the bacilli anaerobically in broth to which sterile, unheated skeletal muscle of the pigeon or rabbit has been added, a highly toxic fluid is obtained. The toxicity of the fluid is independent of acid and is not essentially influenced by filtration through porcelain which removes the bacilli. The degree of toxicity is also very high if the incubation has not been continued too long. For example, 0.25 c.c. of such a filtered fluid injected into the breast muscle of the pigeon produces intense edema and degeneration of the muscle, and death in a few hours. Corresponding lesions are also produced in the guineapig and rabbit. In other words, aside from actual gas formation, the essential lesions arising in Bacillus welchii infection in animals are reproducible with this toxic fluid. The toxic substances are thermolabilc. They have been distinguished into a hemolysin which destroys the red corpuscles and another poison not acting on the blood directly, but nevertheless lethal in effects. If rabbits and other animals arc immunized with the toxic filtrate, (a) active immunity is produced, and (b) an effective antitoxic serum is obtained. With the latter, infection with the bacilli and intoxication with the poison are preventable. The reaction between the immune serum (antitoxin) and toxin conform to the law of multiple proportion. Our experiments lead us to place the pathogenic members of the Bacillus welchii group in the class of toxin-producing bacteria, and to ascribe to them invasive and poisonous properties of their own which are directly responsible for many of the severities observed in connection with the wound infections of the war. They also indicate that by suitable methods of preparation a protective and curative immune serum may be produced. A detailed account of the experiments on which these statements are based will appear in a forthcoming number of the Journal of Experimental Medicine. Hospital of the association has recently been issued covering a period of four years. The feature which this report particularly emphasizes is that by their plan many of the patients have been enabled to return to their work. The hospital has found that the care of children in homes where one or both of the parents are tuberculous, constitutes one of its greatest problems. They find that nearly one third of the children in such families are afflicted with tuberculosis, while many more than one third are delicate or underweight. Of 140 adult patients who have been treated in the hospital for more than three months and who followed advice, only ten died and seventeen were reported as unimproved. In sixty cases the disease was definitely arrested, thirteen were reported improved, twentylive as apparently arrested, and fifteen as quiescent.