Skin-Grafting.

By T. J. Briggs, M. D.

CASE I. SKIN-GRAFTING WITH CALLUS
SHAVINGS, IN BLOOD.

Mary M.; age 60 years; Irish. Diagnosis, Ulcer of Leg. Patient admitted to Hospital, March 3, 1902. She had a. large varicose ulcer situated over the tibia, about 312 by 2 inches. This condition had existed for nine years, and during that time in spite of all treatment employed had never entirely healed. It had been skin-grafted in the old way, three times unsuccessfully. At the time of entering the hospital the patient suffered so severely from pain that at times she would cry out. She was put to bed, secretions regulated, the ulcer cleaned up by means of a dermal curette, and dressed for the first twenty-four hours with a Thiersch pack. On the morning of March 5th, after the surface had been thoroughly cleaned up, a bovinine-pure pack was applied and kept wet with the bovinine for twenty-four hours.

On the morning of the 7th, I determined to employ grafts secured from a callus on the small toe, in order to demonstrate the technique of this mode of skin-grafting to five visiting physicians. The mode of procedure was as follows: The callus was thoroughly scrubbed up, and the external layers scraped off. Then thin sections of the layers next to the true skin were obtained by means of a very keen razor. Nine of these were deposited on the ulcerous surface. Over these were laid strips of perforated rubber tissue, then strips of plain bi-sterilized gauze saturated in bovinine, and a bandage applied. The nurse was instructed to keep the dressings wet with bovinine pure. This dressing was removed on the. 14th, and it was found, much to the delight and astonishment of the visiting physicians, that out of the

nine grafts employed eight were firmly adherent and in a healthy growing condition. The ninth had become displaced and was removed. The wound was now dressed with bovinine pure; the dressings being kept wet, and changed once in twenty-four hours. Co-incident with the local dressings, from the outset, the patient had been given a wineglassful of bovinine in milk alternating with wine and beer every three hours. On March 24th she was discharged cured, the entire surface having become covered with new, healthy skin.

This experiment has been employed frequently enough by me to demonstrate that where the technique is carefully followed it will in the majority of cases yield the most gratifying results. A point of interest in this case and a usual one, is that from the day of the first dressing of the bovinine up to the time the patient was discharged, she was relieved of all pain.

CASE II, SKIN-GRAFTING WITH SKIN-
SCRAPINGS, IN BLOOD.

Anna H.; age 12 years; American. Diagnosis, burn of right hand. Patient was admitted to hospital March 8th, 1902. As a result of the burn she had on the back of her hand an ulcerous surface 2 by 134 inches, very painful, and in spite of three months' treatment had refused to heal. It was impossible in this case to secure skin-grafts, and as I wished to demonstrate to the visiting physicians who were present the efficacy of skin scrapings as a means of bringing about a rapid healing of small surfaces where grafts could not be obtained, with an ordinary vaccinating comb I secured skin scrapings from the little patient's arms, legs and back. These were deposited within the periphery and dressed as in the other case. The dressing was

kept wet with bovinine pure until the morning of the 16th, at which time it was removed and to the delight of the visiting physicians as before, the surface was found to be almost entirely healed, there remaining unhealed only a small space about the size of a ten-cent piece, in the center. The wound was now dressed with bovinine pure and the nurse ordered to change it every 24 hours. Internally the patient had been getting a teaspoonful of bovinine every two hours in peptonized milk. March 24th, she was discharged cured.

CASE III. SKIN GRAFTS HEALED IN 6 DAYS,

WITH BLOOD.

Arnold L., age 24 years, German. Diagnosis, wound of the left cheek, the result of being thrown from a street car. Patient adimtted to hospital March 10th, 1902. The wound was filled with gravel and dirt, and involved almost the entire side of the face. A space in the center of the cheek, 2 by 11⁄2 inches, was completely denuded of skin. In this case it. being desirable to have the wound heal rapidly and with no evidence of scar, I determined to use grafts of normal skin sufficiently large to entirely cover the denuded surface. These grafts were secured from the patient's arms. The wound was dressed as in the other cases; the dressing being kept wet with bovinine. March 17th, the dressing was removed, and the wound was entirely healed, leaving no evidence of a scar whatever; but around the periphery there was some decided redness. This is probably the most rapid case of healing of this class on record.

CASE IV. GREAT 12-YEAR OLD ULCER

HEALED WITH APPLIED BLOOD, WITH-
OUT SKIN-GRAFTING.

Mike L.; age 57, Irish. Diagnosis, ulcer of left leg. Admitted to hospital

March 3, 1902. This condition was of about 12 years' standing, and during that time had never entirely healed. He had been treated at various hospitals and at various clinics and by private physicians, but said that he got no special relief. The ulcer was a large one situated on the calf of the leg, being 4 by 334 inches. It was covered with unhealthy granulations which exuded a foul-smelling purulent discharge. The surface of the ulcer was thoroughly cleaned up with a dermal curette, and dressed with a wet Thiersch pack. This was kept wet At the and not changed in 24 hours. end of the 24 hours this dressing was removed, the wound thoroughly cleansed with bovinine and hydrozone reaction, followed by Thiersch irrigation, and dressed with bovinine pure. The bovinine dressings were changed twice in 24 hours, and the patient got a wineglassful of bovinine internally every three hours. March 23d, the ulcer had healed with the exception of a small space at the upper periphery. This was touched up with a 25 per cent. solution of pyrozone and dressed with bovinine pure; the dressings being renewed twice in 24 hours. March 30th, the patient was discharged cured; the ulcer having become covered with healthy skin, and no scar tissue, it being almost impossible to tell it from. the surrounding skin, the only difference being that it was a little redder.

DR. ALFRED MAYER (N. Y. State Med. Soc.) said that for poor patients, unable to get away from the city, the fire escapes of tenement houses proved an excellent place to recommend to consumptives. Practitioners among the poor must not forget this means of keeping patients constantly in the open air, which is, after all, the main feature of the modern treatment of tuberculosis.