Gas Gangrene as Seen at the Casualty Clearing Stations

The author regards gas gangrene as a very striking feature in the surgery of war, Because of its frequency it has ceased to arouse wonder, and is in danger of being accepted as a necessary evil and treated by routine measures.He comments on two articles by D'Este Emery and K. Taylor.Emery's view he states as follows : " The toxin kills the leuco cytes which are the natural protection of the body.To have a sufficient supply of these it is necessary that the circulation be intact.Therefore tissue devitalized by trauma, by constriction of the limb, or by actual damage, will favor the disease.Why, however, does the disease not stop when healthy tissue is reached?The explanation lies in the fact, that the toxin when present in large amount inhibits emigration and kills the leucocytes.If there is no free escape the toxin accumulates to such an extent that it soaks through into the healthy tissue and kills the defensive leucocyte and so the gangrene spreads."Taylor's view he states as follows : " The mechanical action of the pressure produced by-the gas is usually if not always the most important part of the infection.It brings about the death of the tissues from (a) the resulting anemia, (b) the actual mechanical fragmentation of the muscfe substance, (c) the mechanical scatter ing of the infection.He shows in the early part of his paper that