1919 Journal of the American Medical Association  
within 15 degrees of a straight line. The teeth were in poor condition. The eyes showed normal reaction of the pupils to light and distance. The reflexes were lively throughout. The heart showed a soft mitral systolic murmur. The lungs and abdomen were negative. The back of the left hand and forearm were covered with large blisters. There were also blisters over the dorsal surface of the fingers and thumb. The cutaneous covering had been removed from the blisters of the back of the hand,
more » ... of the hand, leaving a large oozing surface. All the nails were black. The thumb was black for S mm. on the palmar surface. The gangreaous area extended through, to the nail. There was also a black ring extending around the thumb over the last joint. The skin over all the gangrenous area was extremely shriveled, dry and hard. The index finger was dead and shrunken from the middle phalangeal joint. The middle finger was also dead, black and shrunken within 5 mm. of the middle phalangeal joint. The ring finger had a well marked line of gangrene midway between the second and third phalangeal joint. About one half of the last phalangeal joint of both little finger and thumb were gangrenous. There were a number of blisters over the tops of the fingers and thumbs, each containing quite a little pus. The muscles of the forearm were very hard, and the entire cutaneous covering of the forearm and hand, excepting where raw areas were, was shrunken, hard and thick. There was very slight sensation for hot and cold over the hand and fingers and very little pain sensation on being stuck with a pin. The wrist could be moved slightly. Operation and Result.-September 11, under ether anes¬ thesia, I amputated the thumb slightly distal to the end of the last phalanx. The index finger was amputated 1 cm. proximal to the middle phalangeal joint. The middle finger was disarticulated at the middle phalangeal joint. Owing to the desire to save as much of the fingers as possible, the ring finger was amputated 1 cm. distal to the middle phalan¬ geal joint. Five mm. of tissue were removed from the end of the little finger. The wound healed in a surprisingly kind manner. At this time there is increased motion of the elbow joint, (lie wrist and some of the finger stumps. Sensation has greatly improved. The oozing areas of the hand are entirely healed. Schweiter Building. It is often desirable to outline a figure on the skin, but it is not always easy to do so. A skin pencil is not always available, and one, even of the best quality, marks the skin with some difficulty. According to a method suggested by Béclère,1 the spot to be marked is wiped off with a bit of cotton wet with gasoline. This moistened surface can then very readily be marked with a "paper pencil." This method has the objection that gasoline must be at hand, and also that on an inflamed or broken surface this preliminary appli¬ cation of gasoline is irritating or painful. A much simpler method, without the objection of irritation, is to moisten the surface with water from a cotton sponge, and then use an ordinary copying pencil. The lead of a copying pencil marks with ease on the moistened skin. With this method it is perfectly easy to outline with a distinct violet line any area on the skin. Such markings can be made even on a sterile surface by first washing the end of the pencil in a concentrated solution of mercuric chlorid, and by moistening the sufface with a sterile solution. The mark can readily be wiped off with soap and water. The purple lines may be photographed, but not very well. 7 West Madison Street.
doi:10.1001/jama.1919.02610470048014 fatcat:vzedlkw3zjfpjkgadjxkp73y6q