rough removal under
an anaesthetic of all the sloughy tissue, with the surrounding zone in
which the organisms are active. This is most efficiently accomplished by
the knife or scissors, cutting until the tissue bleeds freely, after
which the raw surface is painted with undiluted carbolic acid and
dressed with iodoform gauze. It may be necessary to remove large pieces
of bone when the necrotic process has implicated the jaws. The mouth
must be constantly sprayed with peroxide of hydrogen, and washed out
with a disinfectant and deodorant lotion, such as Condy's fluid. The
patient's general condition calls for free stimulation.

The deformity resulting from these necessarily heroic measures is not so
great as might be expected, and can be further diminished by plastic
operations, which should be undertaken before cicatricial contraction
has occurred.

BED-SORES

Bed-sores are most frequently met with in old and debilitated patients,
or in those whose tissues are devitalised by acute or chronic diseases
associated with stagnation of blood in the peripheral veins. Any
interference with the nerve-supply of the skin, whether from injury or
disease of the central nervous system or of the peripheral nerves,
strongly predisposes to the formation of bed-sores. Prolonged and
excessive pressure over a bony prominence, especially if the parts be
moist with skin secretions, urine, or wound discharges, determines the
formation of a sore. Excoriations, which may develop into true
bed-sores, sometimes form where two skin surfaces remain constantly
apposed, as in the region of the scrotum or labium, under pendulous
mammae, or between fingers or toes confined in a splint.

[Illustration: FIG. 24.--Acute Bed-Sores over Right Buttock.]

_Clinical Features._--Two clinical varieties are met with--the acute
and the chronic bed-sore.

The _acute_ bed-sore usually occurs over the sacrum or buttock. It
develops rapidly after spinal injuries and in the course of certain
brain diseases. The part affected becomes red and congested, while the
surrounding parts are oedematous and swollen, blisters form, and the skin
loses its vitality (Fig. 24).

In advanced cases of general paralysis of the insane, a peculiar form of
acute bed-sore beginning as a blister, and passing on to the formation
of a black, dry eschar, which slowly separates, occurs on such parts as
the medial side of the knee, the angle of the scapula, and the heel.

The _chronic