Page:The third Huxley lecture.pdf/12

8 with carrying out the treatment. This consisted in scraping away very thoroughly under chloroform the brown pultaceous slough and freely applying acid pernitrate of mercury to the exposed surface. The result was, as a rule, that, when the eschar caused by the powerful caustic separated under poulticing, a perfectly healthy granulating sore was disclosed which healed kindly under ordinary dressings. The only exception to this rule was in the case of a very stout woman, in whom the disease attacked an enormous wound of the forearm caused by an accident which had raised a very large flap of skin. In that case the (caustic application removed indeed the pain and the extensive inflammatory blush; but when the slough separated, a small brown spot was seen at one place among the otherwise healthy granulations, and this spread with astonishing rapidity over the entire sore. The treatment was tried again and again with the same result, till, the deep structures of the limb having become seriously involved, Mr. Erichsen resolved to amputate. On the evening before the day fixed for the operation I again put the patient under chloroform and, after scraping the sore very thoroughly allowed the liquid caustic to lie in pools upon it for a quarter of an hour in order to destroy as effectually as possible all material in the sore which might otherwise infect the amputation wound. With a similar object I washed the skin of the limb thoroughly with soap and water, including the shoulder, where it had been decided to perform the amputation. The limb