An Essay on the Application of the Lunar Caustic in the Cure of Certain Wounds and Ulcers Part 2

On the following day, I found that my patient had slept well for the first time since the developement of inflammation, and had suffered far less, after the smarting pain from the application of the caustic had subsided, than before; the punctured orifices were open, and the skin, which was extremely tense the day before, was become soft and flexible.

From this time, I found nothing necessary but to repeat the application of the caustic about every third day to subdue inflammation and to keep the wounds open, which it always effected.

The joint ever afterwards remained stiff, from which we may infer the violence of the inflammation; and when we consider what was the const.i.tution of my patient, we cannot, I think, doubt that the caustic prevented many serious events usually consequent in such cases under the ordinary treatment.

It is highly worthy of remark, that the good effects of the application of the caustic, in this case, were too immediate and distinct to be mistaken.

CASE VIII.

This case ill.u.s.trates the mode of treatment by the lunar caustic, of those terrible effects of punctured wounds which have been neglected in the beginning.

B. Unwin, aged 40, washerwoman, applied to me on July the 10th, 1820, with severe inflammation and ulceration of the middle finger, arising from a puncture by a pin or needle some time before; there was much painful tumefaction, and the integuments had burst along nearly half of the length of the finger, on the ulnar side, and over the middle joint on the radial side; the probe did not however pa.s.s to the bone or into the joint. I applied the lunar caustic deep in every part, and over the whole surface, and enveloped the finger in a cold poultice covered with cold water.

On the 11th she reported that she had slept well for the first time during the last fortnight; to-day there is scarcely any pain, but she complains of soreness; the swelling has greatly subsided. The caustic was again applied and the poultice and lotion continued.

On the 12th there were still swelling and pain; there was considerable bleeding from the wound, so that I could not apply the caustic well.

On the 13th the swelling and pain were nearly gone. I repeated the caustic which induced bleeding from the fungous flesh.

On the 14th the swelling had nearly subsided; the cuticle was separating all over the finger. The lunar caustic was applied extensively over the wound and abraded parts and induced little bleeding or pain.

On the 15th the fungous was nearly removed; the wound presented an appearance of slough over its surface.--The caustic was applied to the remaining fungous.

On the 17th the wound was much smaller and the slough separating. The caustic and cataplasm were applied as before.--A similar report was made on the succeeding day.

On the 20th the slough was separating. The caustic and cataplasm were applied.--A similar report was made on the 22d.

On the 24th the slough having separated the integuments over it were flabby and loose; the caustic was applied to them.

By a continuation of this plan the wound gradually contracted, and, at length, when there was no further use for the cataplasm, the eschar became adherent and the sore healed underneath. It appeared highly probable to me that, under ordinary treatment, the finger, in this case, would have been lost.

I shall in this place, introduce a few observations on wounds received during dissection.

It is not in my power to give any cases in ill.u.s.tration of the treatment of the severer accidents resulting from these wounds; for since I began the free use of the lunar caustic all the terrible effects of such wounds have been invariably prevented.

I may here mention that in the years 1813 and 1819, respectively, I was myself exposed to great danger from inoculation during the examination of dead bodies. Since the latter period I have repeatedly been exposed to the same danger from inoculation, but in every instance, the danger has been completely averted by the prompt and free application of the lunar caustic.

The following is the exact mode of treatment which I would adopt in such cases.

In recent punctures the caustic should be applied in the manner already described in cases of simple punctured wounds.

When the case has been neglected, a small tumour is usually formed underneath the skin with smart stinging pain; this tumour should be removed entirely by the lancet, and the caustic should be applied, both to the surface of the wound and over the surrounding skin, to form an adherent eschar.

When the case has been still longer neglected, and inflammation of the absorbents has supervened, a free crucial incision is to be made, the caustic is to be very freely applied, and afterwards a cold poultice and lotion, the usual const.i.tutional remedies being actively enforced.

In connexion with punctured wounds I here subjoin several cases of the bites of animals.

CASE IX.

James Joynes, aged 12, was bitten by an a.s.s, on each side of the middle finger; the wounds were severe, and almost immediately followed by swelling and great pain. The lunar caustic was well applied within half an hour after the accident.

On the succeeding day, the eschar was found to be quite adherent, and the pain and swelling had subsided.

The eschar separated in about twelve days and the wounds were healed.

CASE X.

Mr. Worth's daughter, aged six, was thrown down by a dog and bitten severely on the face and forehead in three places; one of the wounds in the cheek was deep from the penetration of the dog's front teeth, and the parts were much bruised. The lunar caustic was well applied in half an hour after the accident to each of the wounds, and the eschar was covered with gold-beater's skin.

On the next day the eschars were adherent. There was some swelling from the severity of the bruise; but the child made little complaint.

On the third day, the swelling remained as before and the eschar adherent. On the fourth, the swelling had nearly disappeared.--The eschar separated in nine days from the infliction of the wound, leaving the parts healed and free from scar.

CASE XI.

Mrs. G. was bitten by a little dog on forefinger about a fortnight ago. There is now a very irritable, inflamed, fungous sore. I removed the fungous by a pair of scissors and applied the lunar caustic to form an eschar.

On the succeeding day, I found that the patient had applied a little lint before the eschar was dry, which had prevented it from remaining adherent. I reapplied the caustic and desired that the eschar might be exposed to dry.

The eschar remained adherent, the inflammation subsided and the case gave no further trouble.

CASE XII.

A servant maid was bitten by a dog in four places--severely on the forearm--three days ago. Adhesive plaster had been applied. There is a wound across the arm two inches in length and three-fourths of an inch in breadth, attended by dull pain, and swelling of the arm. I applied the caustic to form an eschar, covering it with goldbeater's skin.

On the following day the eschar remained adherent round the edges, but had a puffy feel in the centre; I pierced it with a penknife and a little b.l.o.o.d.y fluid escaped, and I touched the orifice thus made with the caustic. The swelling remained as before, with a degree of soreness.

On the next day the swelling had subsided. The eschar had the same character; a little fluid was again evacuated and the caustic applied to the orifice as before.

This mode of treatment was pursued for nine successive days when the eschar remained adherent in every part.

This patient continued her usual avocations all along. Under any other plan of treatment I think it impossible that she should not have been compelled to rest for a number of days.

Adherent eschars were formed on the other three bites which were less severe, from the first application.

A very irritable sore sometimes forms after the application of leeches. I knew one lady who was confined during five weeks with several sores on her foot from such a case. I have no doubt that the application of the caustic would have prevented all the inconvenience and suffering she experienced. This observation will be confirmed by the following case.

CASE XIII.