Clostridia in Gas Gangrene and Local Anaerobic Infections during the Italian Campaign.

When World War II began, some of the experimental results obtained on animals indicated that sulfonamides applied locally and taken by mouth might prevent infections with anaerobes of the gas gangrene group. It became evident, even in the Western Desert and Tunisia, that anaerobic infections would occur in spite of sulfonamide prophylaxis. When the fighting took place on the more cultivated soil in Sicily and Italy, the incidence of gas gangrene increased. Antiserums made in the United States, usually containing antitoxin only for Clostridium perfringens (B. welchii) and Clostridium septicum, did not appear to prevent gas gangrene and were of limited value in the therapy of cases (Jergesen, 1944). The question arose as to the incidence of Clostridium novyi (B. oedematiens) in anaerobic infections; it was questioned if the poor results with serum could be attributed to the lack of C. novyi antitoxin in some American polyvalent gas gangrene antiserums. In order to determine the incidence of C. novyi, the clostridial flora of 25 cases of gas gangrene that occurred in Italy was studied (Stock, 1944). In a second study, made while the fighting was in the Northern Apennines, 5 additional cases of gas gangrene and 7 of local anaerobic infections were cultured, and at the same time an effort was made to determine the incidence and significance of positive blood cultures. It appeared important to learn whether therapy could save a case of gas gangrene once the causative organisms had entered the blood stream. Although only the preliminaxy phase of the latter study was completed, it may be of value to record these results and to summarze our entire findings because so few reports on cultures in gas gangrene or other anaerobic infection in World War II have appeared (MacLennan, 1943, 1944; MacLennan and Macfarlane, 1944; Jeffrey and Thomson, 1944; Smith and George, 1946).