Martin has shown that, after many hours of exposure in the open air at a temperature of nearly 32 degrees F., grafts could be successfully applied, but in such temperatures as 82 degrees F., exposure of from six to seven hours destroyed their vitality, so that if kept cool, the limb of a healthy individual amputated for some accident, may be utilized for grafting purposes.
Reverdin originated the procedure of epidermic grafting. Small grafts the size of a pin-head doing quite as well as large ones.
Unfortunately but little diminution of the cicatricial contraction is effected by Reverdin's method. Thiersch contends that healing of a granulated surface results first from a conversion of the soft, vascular granulation-papillae, by contraction of some of their elements into young connective-tissue cells, into "dry, cicatricial papillae,"actually approximating the surrounding tissues. thus diminishing the area to be covered by epidermis; and, secondly, by the covering of these papillae by epidermic cells. Thiersch therefore recommends that for the prevention of cicatricial contraction, the grafting be performed with large strips of skin.
Harte gives illustrations of a case of extensive skin-grafting on the thigh from six inches above the great trochanter well over the median line anteriorly and over the buttock. This extent is shown in Figure 228, taken five months after the accident, when the granulations had grown over the edge about an inch. Figure 229 shows the surface of the wound, six and one-half months after the accident and three months after the applications of numerous skin-grafts.
Cases of self-mutilation may be divided into three classes:--those in which the injuries are inflicted in a moment of temporary insanity from hallucinations or melancholia; with suicidal intent; and in religious frenzy or emotion.
Self-mutilation is seen in the lower animals, and Kennedy, in mentioning the case of a hydrocephalic child who ate off its entire under lip, speaks also of a dog, of cats, and of a lioness who ate off their tails. Kennedy mentions the habit in young children of biting the finger-nails as an evidence of infantile trend toward self-mutilation. In the same discussion Collins states that he knew of an instance in India in which a horse lay down, deliberately exposing his anus, and allowing the crows to pick and eat his whole rectum. In temporary insanity, in fury, or in grief, the lower animals have been noticed by naturalists to mutilate themselves.
Self-mutilation in man is almost invariably the result of meditation over the generative function, and the great majority of cases of this nature are avulsions or amputations of some parts of the genitalia. The older records are full of such instances. Benivenius, Blanchard, Knackstedt, and Schenck cite cases. Smetius mentions castration which was effected by using the finger-nails, and there is an old record in which a man avulsed his own genitals. Scott mentions an instance in which a man amputated his genitals and recovered without subsequent symptoms. Gockelius speaks of self-castration in a ruptured man, and Golding, Guyon, Louis, Laugier, the Ephemerides, Alix, Marstral, and others, record instances of self- castration. In his Essays Montaigne mentions an instance of complete castration performed by the individual himself.
Thiersch mentions a case of a man who circumcised himself when eighteen. He married in 1870, and upon being told that he was a father he slit up the hypogastrium from the symphysis pubis to the umbilicus, so that the omentum protruded; he said his object was to obtain a view of the interior. Although the knife was dirty and blunt, the wound healed after the removal of the extruding omentum. A year later he laid open one side of the scrotum. The prolapsed testicle was replaced, and the wound healed without serious effect. He again laid open his abdomen in 1880, the wound again healing notwithstanding the prolapse of the omentum. In May of the same year he removed the right testicle, and sewed the wound up himself. Four days later the left was treated the same way. The spermatic cord however escaped, and a hematoma, the size of a child's head, formed on account of which he had to go to the hospital. This man acted under an uncontrollable impulse to mutilate himself, and claimed that until he castrated himself he had no peace of mind.
There is a similar report in an Italian journal which was quoted in London. It described a student at law, of delicate complexion, who at the age of fourteen gave himself up to masturbation. He continually studied until the age of nineteen, when he fell into a state of dulness, and complained that his head felt as if compressed by a circle of fire. He said that a voice kept muttering to him that his generative organs were abnormally deformed or the seat of disease. After that, he imagined that he heard a cry of "amputation! amputation!" Driven by this hallucination, he made his first attempt at self-mutilation ten days later. He was placed in an Asylum at Astino where, though closely watched, he took advantage of the first opportunity and cut off two-thirds of his penis, when the delirium subsided. Camp describes a stout German of thirty-five who, while suffering from delirium tremens, fancied that his enemies were trying to steal his genitals, and seizing a sharp knife he amputated his penis close to the pubes. He threw the severed organ violently at his imaginary pursuers. The hemorrhage was profuse, but ceased spontaneously by the formation of coagulum over the mouth of the divided vessels. The wound was quite healed in six weeks, and he was discharged from the hospital, rational and apparently content with his surgical feat.