NORTHERN DIVISION OF THE ARMY.
95
This patient progressed very satisfactorily up to a certain point, about the 15th day after
admission and the 24th day from the first symptoms of illness, when the fatal lesion of the
bowel occurred, and then he rapidly sank.
The treatment in this case consisted of a mild calomel and rhubarb aperient, with a little
taraxacum given on admission, followed by acetate of ammonia, aconite and chlorate of potass,
every three hours, during the gradual increase of the febrile heat. Tincture cinchona (succirubra)
gum ducalipt rostratœ for the bowel complication, and phosphoric
T
acid ; strong soups, wine and arrack stimulants, were administered
during the few days he felt better. The motions, as a sanitary precaution, were carefully
buried deep in the ground, with lime and carbonate of lime spinkled over them ; and stained
clothes were burned to ashes, and these also were buried. The room in which the man dwelt
was well purified and whitewashed, and every precaution used. No case occurred afterwards.
A curious case of larvæ maggots within the nasal passages and in the cellular tissue of
the face, came under my treatment. A young healthy man ( a Hindoo by caste) rather thin
and slight, was admitted into hospital, complaining of a swollen face and magg maggots within the
nostrils ; he had considerable irritative fever, and a dark grey grumous discharge from both
nostrils ; the eyelids were swollen and watery, and he had considerable difficulty in breathing,
and appeared to be suffering from erythematous inflammation or erysipelas of the face. On
examination, however, a large maggot was drawn out with the forceps, and a very mild injec--
tion of carbolic acid in water brought away several others half dead. On the following morn-
ing I extracted several others uninjured and kept them to be
Treatment.
reared. Ammonia was inhaled as strong as could be borne and
it brought away a few more. The fumes of acetic acid, on a hot tile, brought away
a few, and the vapour of carbolic acid, on a hot brick, gently inhaled, answered pretty well
while they continued in the nasal passages ; but they had burrowed and formed sacs or
cysts, containing several in each, all over the face, and under the frontal aponeurosis beneath
the orbicularis palpebrarum at its lower aspect, and the compressor
Mischief produced.
naris, and below the zygomatici muscles on each side, each cell and
channel had to be punctured and flooded with weak solution of iodine. Tinture iodine
.
3i, aqua 3 iii. This either destroyed them in situ, or drove
Treament
them out into the nasal passages, where they could be picked out.
Weak solution of carbolic acid, chloride of lime, turpentine in oil, did not succeed ; iodine
alone seemed to kill them, though not immediately, and it had the advantage of destroying
the fine secreting membrane which each sac was beginning to assume, and which might have
become a permanent fistula. No great irritation was set up by this treatment. I fed some of
the larvæ on liver for a few days, when each became dormant and about to become a chrysalis
which I placed on dried horse dung in a bottle. Others I preserved in spirits which I beg
to forward herewith for inspection and further investigation. On the 26th day two of them
became large grey flies which I found clinging to the sides of the bottle, on the 27th day three
others were liberated, and on the 31st day the last one came forth. They were bright clean
and healthy insects, nearly as large as an ordinary blue bottle fly, but longer and thinner in
shape, each with a slightly bronzed pink tinge on the back and body, and a very fine pink
stripe on each side of the head and back, and the colour was drab grey throughout ; these I
also preserved to forward, but unfortunately they were completely consumed by black and
small red ants during the night, the pins only remaining. .
Skin-grafting in shoesores and all indolent ulcers has been very successful, especially in
cases that present a low cachectic or scorbutic taint. (Such cases are
Skin-grafting on indolent
ulcers.
most frequently admitted into the General Staff Hospital). But
there are certain facts not hitherto observed in skin-grafting to which
I would call attention, as I consider the operation would be incomplete without their observ-
ance. The operation is simple, it consists in denuding an ulcerated surface down to healthy
structure and thereon planting and fixing a piece of healthy skin taken from another part of
the body or from another person, which will in a day or two soften down and disappear ; but
it has already germinated and taken firm root, and new skin will in time appear like a little
speck or island in the centre of that spot, and it will gradually grow and extend until the
periphery is reached in a stellate, branching, or irregular manner.
Briefly then—the skin consists of an external covering of epithelium—" the epidermis"
next to which is the " cutis vera"—and below that the vascular tissue, named the " corium,"
and with each of these component parts successful grafting can be accomplished. Even a thin
layer of true epithelium alone will engraft itself and grow, so will a piece of the cutis vera,
stripped of its epithelium, as will also a layer of the true vascular corium; but the resulting
skin is not in either case perfect. A piece of healthy skin, consisting of all three, is generally
used, and is almost always successful ; but I am of opinion, that even a deeper layer of skin is
necessary, including those structures situate beneath the corium, which have special and dis-