Modified Goodell Dilator
Journal of the American Medical Association (JAMA)
This lesion occurred in a seaman, aged 24, native of Denmark, who was admitted to the U. S. Marine-Hospital, Chicago, August 22, 1899. The patient gave a history of having had chills and fever while serving in the Spanish-American war, and presented a malarial cachexia. The day before admission he was struck on the inner side of the left leg by a piece of lumber, producing a slight abrasion of the skin. The following night, and again the next day, he had a severe chill, followed by
... C.\p=m-\and intense headache. On examination, no bad effects were apparent, excepting a slight contusion at the point of injury; a continuous high temperature and accelerated pulse led to the suspicion of pus infection, which subsequently proved to be the case. The patient soon complained of pain, and the examination showed indications of the infective process. A free incision was made in the midle of the leg, evacuating a large amount of pus; but unfortunately no examination was made with a view to determining the character of the pus germ, though from the previous history of the patient the plasmodium malarias undoubtedly was an important etiological factor in the case. Two days later another incision was made near the tendo Achillis and a drainage-tube carried through to the first incision, establishing free drainage, and the limb was immersed in a 1 to 2000 bichlorid solution. Despite careful antiseptic treatment, the wound during the following eight days underwent extensive sloughing, which required the removal of a large area of skin and subcutaneous tissue. Several sinuses in the popliteal space and lower portion of the leg were laid open, and as soon as the wound appeared to be in the proper condition, skin grafting was commenced by Thiersch's method. After several attempts the grafts became firmly imbedded, and a month later, almost the entire granulating area was covered, with the exception of a small spot on the lower portion, and another in the popliteal space, which remained unhealed.