K. Goadby
1918 BMJ (Clinical Research Edition)  
THE wounds of war differ from the majority of wounds in civil life in that they contain a very large nurmber of bacteria, resulting in -prolonged suppuration, slow healing, and deforming cicatrization. In no industrial wounds, except a limited number occurring in agriculturists, does soil contamiination play such an important part as in the wounds of war, and as the bacteria of the soil figure largely in the flora of war wounds, a comparative study of the bacterial flora of the wounds extending
more » ... he wounds extending over long periods may throw some light on the benefit of one or other method of wound treatment, and suggest a direction in whtich effort should be. concentrated. From the commencement of tlle war I have made routine bacteriological examinations of tle convoy cases arriving in certain home hospitals; these examinations have been conducted in a uniform manner tlhroughout. The routine adopted lhas been (a) the examination of film preparations DIAGRAM I. -Percentage incidence of spores (shaded), bacilli (black), and cocci (white), in Gram-stained films. Periods of six mnonths, 1915-17. of the diseharge material stained by the Gram metlhod, (b) the ctltivation of the discharge material on (1) glucose broth, (2) stelrilized milk, (3) minced autoclaved meat. The cultures Avere examined in the ordinary routine manner and where necessary plated otat, or the cultures carried far enough to determine the various groups in whichl the organisms are scheduled. A considerable amount of effort was expended to commence with in perfecting anaerobic apparatus, and tile results and methods have been publislhed elsewhere. Certain general conclusions regalrding the bacteriological flora of wounds have been reached. In thje early part of the war, especially in tlle winter of 1914-15, niany wounds arriving in home hospitals were extremnely septic, slouglliig, and emnitted an offensive putrid odour. At intervals during the succeeding years a sliglht return to this condition has occurred from time to tiilne, during periods of stress. but tthe general physiological character of the wounds has undergone a steady and progressive improvement. In the early period tlhe number of sporebearing organisms found in films made from the wounid discharges was large. Thlree types of sporing organismns were observed: (1) Bacilli witlh a central spore, staining deeply by Gram's metlhod; (2) bacilli containing a subterminal spore; (3) bacilli with a rounded or oval endspore. In the more putrid wounds all three classes were represented, but mainly the third, wliereas in the cases of iente localized oedema with bubbles of gas in tlle discharge and, in a few cases, acute gas gangrene spreading from the wound, the main class of organism present was the central spored bacillus. During 1916 and the first half of 1917 these organisms were less often met with; during the last half of 1917 a limited number only were observed. Diagram I shows the relative percentage incidence of the various classes of organism met with in the pus films. The cases are collected into periods of six months, commencing with 1915, and the number of cases with sporebearing organisms shows an extraordinary and progressive diminution, except for a slight rise during the second lhalf of 1916. These relative proportional diagrams do not convey the intensity of the infection in any given wound, but merely the percentage of cases in which spore-forming bacteria, were found in the. pus films. Thje other two columns represent the white column cocci, both streptococci and staphylococci, and the black column bacilli, both Gram-positive and Gram-negative. During the first two years Gram-negative bacilli .belonging to the coli and proteus groups were frequently met witlb, but the incidence of these organisms, especially the prote'us group, has diminished duringthe last nine months. The cases from whichi these examinations are made were all examined within twenty days of wounding. About 33 per cent. were examined witlhin tle first weel; this proportion has been maintained tlhroughout, so that tlle groups of cases remain fairly comparable. The results of treatment appear, therefore, to have progressively diminished wouind infection, but it by no means follows that the absence of bacteria in the films. of the discharge is indicative of the freedom of suclh wounds from bacterial infection. Diag-am II shows how far this divergence exists; in tljis diagram the proportional incidence of bacteria in the ISJ 2~AI
doi:10.1136/bmj.1.2995.581 fatcat:2btrwadm3rf4tfhdkc75la5xca