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War Surgery and Medicine

Treatment of Infection

Treatment of Infection

When infection developed, the treatment in the early period consisted in the provision of adequate dependent and other drainage, and at first the parenteral administration of sulphonamides. The sulphonamides in general were not successful in the treatment of gross infection but were of use in streptococcal cases. Local injection of the wound with antiseptics of different kinds was then utilised and the Carrel-Dakin treatment reintroduced, using electrolytic hypochlorite and new antiseptics such as 5 Ammo-Acridine-HCL.

The difficulty of controlling infection at that period is illustrated by a visit to a British hospital in July 1943, when a ward full of late cases of fracture of the femur was inspected. The hospital had a very efficient and active staff, and the condition of the patient was not due to any neglect of treatment, but to the inability of treatment at that time to cope adequately with infection in many cases. The condition of these patients created an unforgettable impression. They were usually thin and very anaemic. The wounds were very septic, and the smell of pus pervaded the ward. There were many cases of non-union. Various methods were being utilised in these cases to clear up the infection, including the use of electrolytic hypochlorites given by the Carrel-Dakin method. Fixation in plaster with free drainage was also used, combined with local applications to the wound through a window cut in the plaster.

The introduction of penicillin brought about great improvement, especially in the treatment of established gram-positive infection. Local treatment by injection was utilised, but parenteral administration was of more value and in particular brought about a marked improvement in the general condition of the patient. There was a marked lessening in the incidence of toxic symptoms following its use. The penicillin-resistant gram-negative organisms, though often producing marked local signs of infection, produced little general reaction and generally interfered little with wound healing. Pyocyaneus infection, which was common and often persistent, was treated by the local application of 2 per cent acetic acid.

Blood transfusion was of great value in the later stages when anaemia was always well marked. A high protein diet with vitamins was also given.