MASINA: TUMOURS OF of' the gas in bubble form or its presence as crepitus should leave no doubt, because the diagnosis of gas gangrene is clinical. When, however, there is no clinical evidence of the presence of gas the diagnosis is likely to be delayed, and here radiological search for gas is most helpful. An immediate direct smear examination of the pus showing Gram-positive, square-ended rods should reinforce the suspicion. Altemeier (1944) has described a method for rapid identification of Cl. welchii which gives a result within 4-5 hours.
Early and adequate wound surgery (dkbridement with maximum exposure, excision, or amputation) is the most important factor in successful treatment. Hydrogen peroxide dressings or irrigations, and more recently hyperbaric oxygen, create conditions difficult for further clostridial proliferation. Intravenous crystalline penicillin in dosage of 4-20 million units daily (average 10 million units) has been used successfully by Roberts and Basett (1961) and also by Smucker and others (1960), Taylor (1954), and Altemeier and others (1957). The value of antiserum is uncertain. It has been administered intravenously in the dose range of ~o,ooo-~oo,ooo units spread over 24-48 hours.
Clostridial cellulitis is not usually considered to be a very serious illness. The pathological lesion in Cases I and 2 was predominantly a cellulitis. In both instances it produced a grave picture-fatal in one.
SUMMARY
The literature on spontaneous or non-traumatic gas gangrene is briefly reviewed and I proved and 2 probable cases described.
It is stressed that the diagnosis of gas gangrene is clinical. Radiological examination for detection of THE UKINARY BLADDER 279 gas where none is to be detected clinically is an important aid to diagnosis. Sufficient, though not final, bacteriological confirmation of a provisional diagnosis can be obtained within a few hours.
Adequate and timely surgical treatment is essential, aided by antibiotics given intravenously and in high dosage. Blood transfusions and fluid and electrolyte correction are important. Until such time as the value of antiserum has been assessed, intravenous administration of large doses seems advisable.
Clostridial cellulitis may be fatal.