53S 
CHARLES H. DUNCAN. 
Cases of this kind seldom or never recover, even though ampu¬ 
tation is performed well above the gangrenous area. However, 
as a last resort, the writer decided to amputate the thigh at the 
middle third. This was done, but the skin flaps were not sutured 
together, they were left open and the end of the stump was packed 
with gauze. The incision passed through about five inches of 
what appeared to be gangrenous tissue. This was hard and stiff 
like the back of a book; it was tough and black, and about % of 
an inch thick. The fat globules, where cut, were white and 
shone like glistening pearls set in an ebony background. The 
prognosis, of course, was grave. 
The writer had no idea of saving the patient’s life, but believed 
he would die as he has seen so many similar cases die. However, 
about a cubic centimeter of the necrotic tissue from the foot was 
shaken up well in about four ounces of water. He was given a 
teaspoonful of this every hour for six hours. His temperature 
dropped immediately after the operation. The patient went on 
to an uneventful recovery and the blackened skin flaps did not 
necrose but returned to their original healthy state and the wound 
apparently healed with no slough. 
Then there remains direct inoculation with the toxic product 
of the disease by scarification, or placing the crude discharge on 
a healthy raw surface It may be claimed this is open to the same 
objection, that is, the danger of auto-infecting the case. The 
danger of a superficial infection is not so great as from a punc¬ 
tured wound. This practically is auto-inoculation. It is what the 
tissues themselves are attempting to do. It is the way nature 
cures the tissues. This is the remedy the tissues need; it is the 
remedy the tissues use to cure the condition. It is the substance 
against which the healthy tissues react in a curative man¬ 
ner and it may be that experience will prove that it is not 
easy to auto-infeet the patient in this way in some diseases. Then, 
again, a possible reason for not auto-infecting the patient is on 
account of the lowered vitality of the micro-organisms, especially 
in chronic cases. The writer does not recommend this thera¬ 
peutic measure till after a thorough investigation be made of its 
use. 
