Modern surgery, general and operative . Bacillus perfringens, or Bacillus perfringensand sporogenes, etc. (Quoted in Brit. Med. Jour., March 3, 1917, from , and Elec). Infection without gas bubbles will not show on the thirty-six and forty-eight hours the clinical signs become marked andpositive. The infection does not seem to start in the subcutaneous tissue. Itstarts in the muscular tissue. If gas appears in the subcutaneous tissue it i86 Mortification, Gangrene, or Sphacelus does not form there but reaches there from the muscle (Frankan, Drummoncl,and Neligan in B
Modern surgery, general and operative . Bacillus perfringens, or Bacillus perfringensand sporogenes, etc. (Quoted in Brit. Med. Jour., March 3, 1917, from , and Elec). Infection without gas bubbles will not show on the thirty-six and forty-eight hours the clinical signs become marked andpositive. The infection does not seem to start in the subcutaneous tissue. Itstarts in the muscular tissue. If gas appears in the subcutaneous tissue it i86 Mortification, Gangrene, or Sphacelus does not form there but reaches there from the muscle (Frankan, Drummoncl,and Neligan in Brit. Med. Jour., June 2, 1917). The infection spreads withinmuscle sheaths and along fascial planes with very great rapidity, and musclestend particularly to become gangrenous. The rapidity of spread is explainedby the structure of the muscles. The sheaths of individual fibers are easilydetached and when detached form spaces along which toxic matter passes tocause necrosis of the fibers (Wallace, in Brit. Med. Jour., June 2, 1917. (The. Fig. 91.—Showing a gas-bacillus infection of a mutilating shoulder wound, due to a high-explosive shell fragment and accompanied by necrotic infiltration of a large part of the chestwall, which proved fatal. The patient was received 5 days after injury and the necroticmaterial was removed, followed by a continuous irrigation. (By courtesy of the Harvardunit) (Fauntleroy, Report on the Medico-Military Aspect of the European War). process ascends and descends the damaged muscle. A muscle or a group ofmuscles becomes involved. Infection is not apt to spread to adjacentmuscles. In a great majority of cases the infection is in the lower region most liable is the buttock and then, in order, come the thigh, theleg, the arm, the forearm and the foot. The hand is seldom, the face, neck,
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