. Atlas of clinical surgery; with special reference to diagnosis and treatment for practitioners and students. course. Pirogoff described these cases as acute purulentoedema, Maisonneuve as fulminating gangrene, othersas gasphlegmon, gangrenous phlegmon, etc. Theputrid necrosis of wounds known as hospital gan-grene, which was so common in the pre-antisepticdays, appears to be nothing more than putrefactiveinflammation due to gas-forming bacteria. All theseconditions are best included under the name jprogres-sive gaseous ^phlegmon. The causes of these phleg-mons are not well known, as they are
. Atlas of clinical surgery; with special reference to diagnosis and treatment for practitioners and students. course. Pirogoff described these cases as acute purulentoedema, Maisonneuve as fulminating gangrene, othersas gasphlegmon, gangrenous phlegmon, etc. Theputrid necrosis of wounds known as hospital gan-grene, which was so common in the pre-antisepticdays, appears to be nothing more than putrefactiveinflammation due to gas-forming bacteria. All theseconditions are best included under the name jprogres-sive gaseous ^phlegmon. The causes of these phleg-mons are not well known, as they are anterobicbacteria which have not yet been well differen-tiated from each other by bacteriological are found most often in dust, manure andputrid flesh. The bacillus of malignant oedema, the bacillusemphysematosus and the proieus vulgaris are thebacteria at present found, generally in symbiosiswith the ordinary pus-forming bacteria, especiallystreptococci. By this symbiosis the growth of theanaerobic bacteria is at first made possible in openwounds, and through the combined action of both 274. n 5CI U) o to forms of bacteria rapid and extensive destruction oftissue may be caused. Sometimes gaseous phlegmonis found after quite harmless lesions of the skin(Fig. 109), also after compound complicated frac-tures with small wounds. Gaseous phlegmons occur in the extremities; onthe back, in connection with bedsores; in operativewounds on the rectum, through infection by faeces;in the penis, scrotum and perineum, from lesions ofthe urethra with extravasation of urine; in the neck,after lesions of the esophagus and pharynx. Theprogress of gaseous phlegmon is extremely rapid;in a few hours large portions of the body are affectedby the rapid formation of gas. As gaseous phleg-mon may occur after apparently slight injuries, itis necessary to emphasize the necessity of frequentdressings in order to control the progress of infection. The wound becomes dry, coated and fetid, andex
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