The normal result of all bullet wounds was a shattering of tissue, which did not exist in the initial experiments. As a result of the injury, the normal flow of blood through the muscle is cut off. The muscle is nourished by the flow of blood from either end. When this circulation is interrupted, the affected area becomes a fertile field for the growth of bacteria; the normal reaction of the tissue against the bacteria is not possible without circulation.
This interruption of circulation usual in battle casualties could be simulated by tying off the blood vessels at either end of the muscle.
Two series of operations, each involving 10 persons, were begun following this procedure. In the first of these, the same bacterial cultures were used as were developed in the third and fourth series, but the glass and wood were omitted. In the other series, streptococci and staphylococci cultures were used. In the series using the gangrenous culture a severe infection in the area of the incision resulted within 24 hours.
Eight patients out of ten became sick from the gangrenous infection. Cases which showed symptoms of an unspecific or specific inflammation were operated on in accordance with the doctrine and manner of septic surgery. The Lexer doctrine formed the basis of the procedure. The technique is that an incision in the area of the gangrene is made, from healthy tissue to healthy tissue on either side. The wound and fascian corners were laid open, the gangrenous blisters swabbed, and a solution of H2O2 (hydrogen peroxide) was poured over them. The inflamed extremity was immobilized in a cast. With most patients it was possible to improve the gangrenous condition of the entire infected area in this manner.
In the series in which banal cultures of streptococci and staphylococci were used, the severe resultant infection with accompanying increase in temperature and swelling did not occur until 72 hours later. Four patients showed a more serious picture of the disease. In the case of these patients, the normal professional technique of orthodox medicine was followed as outlined above, and the inflamed swelling split. Due to the slight virulence of the bacteria it was possible in the case of all patients except one to prevent the threatened deadly development of the disease.
The incisions were made on the lower part of the leg only in all series to make an amputation possible. It was not made on the upper thigh because then no area for amputation would remain. However, in this series the inflammation was so rapid that there was no remedy and no amputations were made.
Since after the tying up of the circulation of the muscles, a very severe course of infection was to be expected, 5 grams of sulfanilamide were given intravenously in the amount of 1 gram each, beginning 1 hour after the operation. After the wound was laid open to expose all its corners, sulfanilamide was shaken into the entire area and the area was drained by thick rubber tubes.
The infection normally reached an acute stage over a period of 3 weeks, during which time I changed the bandages daily. After the period of 3 weeks the condition was normally that of a simple wound which was dressed by the camp physicians rather than by me.
The procedure prescribed for the post-operative treatment of the patients was to give them three times each day 1 cc. of morphine, and when the dressings were changed, to induce an esthesia by the use of evipan.
In all the series of experiments, except the first, sulfanilamide was used after the gangrenous infection appeared. In each series two persons were not given sulfanilamide as a control to determine its effectiveness. When sulfanilamide and the bacteria cultures together were introduced into the incision no inflammation resulted.