Under the Knife: A History of Surgery in 28 Remarkable Operations

by Arnold van de Laar

Gas gangrene is the deadliest form of gangrene and is mostly caused by a micro-organism with the appropriate name Clostridium perfringens, from the Latin verb perfringere, which means ‘crush’, ‘demolish’, ‘assault’ or ‘break through with violence’. It can be found everywhere on the planet. Sand, soil, faeces and street refuse are full of it. Perfringens comes from a dangerous family. Clostridium tetani causes the lethal disease tetanus, or ‘lockjaw’, Clostridium difficile a life-threatening great bowel infection and Clostridium botulinum deadly food poisoning. In unhygienic conditions, Clostridium perfringens also causes the much-feared childbed fever, which unnecessarily cost the lives of so many women in childbirth in the past. The Clostridium perfringens bacteria is an anaerobic life-form, meaning that it only survives in an oxygen-free environment. The bacteria has two dangerous properties: it emits rotting gases and produces toxic substances known as toxins. For many centuries, surgery was frustrated by gas gangrene and wound infections. But why does one wound become infected and another not, and why would gas gangrene have developed in Peter Stuyvesant’s wound? And why does it hardly occur in the present day? Three elements determine whether an infection or gangrene develop in a wound. Firstly, of course, there has to be a wound. The size of the opening in the skin is not that important. Bacteria are small enough to enter through even the smallest wounds. The second ...