After the discharge of about a pint of bloody pus, the stream was checked by a clot of blood coming into the opening. I enlarged the opening, making it about two inches long, when a clot the size of a hen’s egg came through, followed by about a pint more of bloody pus. After syringing the cavity with a five per cent. solution of carbolic acid in distilled water, and introducing a tent about four inches long, I applied compresses and bandages. Ordered the quinia continued, and whisky and beef tea.
Feb. 16th, 9 a.m.,—pulse 100, but feeble; temp. 97.8. Removed dressings which were saturated with pus and blood. The latter had excited the anxiety of the Superintendent during the night, and he applied an additional bandage. There was perhaps five or six ounces of thick, flaky, yellow pus discharged. No hemorrhage; syringed the cavity with a five per cent. solution as before, and introduced a clean tent.
On examining the inflamed spot over the left ilium, I detected fluctuation over the anterior part of the crest of the ilium, near the gangrenous spot, and extending down over the abdomen. However, it seemed to be superficial, at least, not deeper than the connective tissue between the external and internal oblique muscles, and not more than one inch by two in size. This I opened, and squeezed out about half a ounce of pus. Introduced a tent and applied oakum over both tents, for the purpose of absorbing the pus, and applied a compress over the main sinus or pouch, and a bandage over the whole lower part of the body.
Feb. 17th, 9 a.m.,—pulse 96, temp. 99. Ordered a laxative of carbonate of magnesia. Both openings discharging very freely. The gangrenous spot over the left ilium is separating from the surrounding tissues. Removed considerable dead flesh from this spot, leaving an opening or pouch one inch in diameter, leading down to the pubis, just beneath the oblique muscles.
Feb. 19th, 9 a.m.,—pulse 106, temp. 99.5. Both sinuses discharging very freely. Made an opening in the lower part of the pouch to the left of the pubis for better drainage, as the patient usually lies on the right side. Laxative has operated. After washing out both sinuses with a five per cent. solution of carbolic acid, I inject the smaller sinus with liquid vasaline.
Feb. 20th, 9 a.m.,—pulse 112, temp. 103.5. There is a great amount of pus being discharged from the large sinus on the back, not so much from the small one. Patient had a chill last night. After the usual washing out of the sinuses with the carbolic solution, I inject both of them in with liquid vasaline. This I do, a well as the washing out, by means of a No. 10 catheter, attached to the end of a Davidson’s syringe. The sinus on the back extends from the coccyx to the ribs, and from one ilium to the other. The skin and fascia of the external wall being so thin that the catheter can be seen over the entire extent, as I push it from one part to another for the purpose of washing out all parts of the sack. Patient has been complaining of pain and want of sleep; had a chill last night. He still takes beef tea twice a day, and eggs and other food twice a day, making four meals a day; also, continues the quinine and whisky.
Feb. 21st, 9:30 a.m.,—pulse 98, temp. 101. Feels more comfortable. Discharge of pus much less than yesterday. Wash out the sinuses and inject liquid vasaline.
Feb. 23d, 9:30 a.m.,—pulse 98, temp. 101. Complains of being “very sick.” Speaks English but poorly. Considerable discharge of laudable pus, but not so much as before the use of the liquid vasaline. There is one point near the left hand side of the large sinus on the back, where the walls are adherent. I wash them out with a five per cent. solution of carbolic acid in water, and again inject the liquid vasaline. By gentle pressure made over the upper part of the pouch, I force everything out of it at the opening below, bringing the walls of the sack together over the greater part of the surface. Hoping that the adhesion between the walls, which has commenced, will continue, and soon obliterate, at least, all the upper part of the pouch. Put on the usual compresses; this time using oakum instead of folded cloths.
Feb. 24th, 9:30 a.m.,—pulse 108, temp. 101. Did not wash out the upper or left hand part of the pouch on the back, for fear of disturbing adhesions that are taking place. Washed out the lower part and injected vasaline. A small spot, as large as a ten cent piece, has sloughed, making a hole into the pouch over the lower lumbar vertebra. Another spot immediately above this, and about the same size, looks as if it would slough.
Feb. 25th, 9:30 a.m.,—pulse 100, temp. 100.