An Essay on the Application of the Lunar Caustic in the Cure of Certain Wounds and Ulcers Part 3

Am old man applied leeches to the instep for inflammation occasioned by a bruise. Several very irritable sores were produced with some swelling. I applied the lunar caustic to form an eschar.

On the following day, the eschars were adherent, the swelling had subsided, and he had slept well for the first time of several nights.

I do not, however, think the lunar caustic would succeed in such cases if attended by great inflammation, without the previous application of a cold poultice with rest for a day or two.

II. ON BRUISES.

It has been already observed, p. 9, that the caustic is an invaluable remedy in cases of bruised wounds of the s.h.i.+n. In these, as in all other cases, the value of this remedy is greatly enhanced by an early application. In bruises on the s.h.i.+n I have not had a single instance in which I was not enabled to effect a cure by the adherent eschar, if application was made to me early. The difficulty of forming an adherent eschar is always increased by delay; but in these bruises along the s.h.i.+n there is an additional reason for this increased difficulty, arising out of the tendency observed in them, to the formation of a slough.

In this place I have, indeed, to make an observation of particular interest, both in a pathological and curative point of view; it is, that the formation of this slough has always been prevented by an early application of the caustic, in the cases which have hitherto fallen under my care. This fact may probably admit of explanation in the following manner; the bruise partially destroys the organization of the part, and the subsequent inflammation completing what the injury had partially effected, a loss of vitality takes place, and the slough is formed. The early application of the caustic has already been shown to have the remarkable effect of preventing the inflammation consequent upon certain wounds, and thus the part is suffered to recover from the injury done to its organization, and its vitality is preserved.

Whether this mode of explaining the fact be correct or no, the fact itself is extremely important, for the formation of a slough, which the early application of the caustic can alone prevent, renders it quite impossible to effect the formation of an adherent eschar.

When the patient applies too late after the accident to prevent the formation of a slough we must still treat the case by the caustic. It is to be applied over the bruised and inflamed part. The eschar remains adherent round the part occupied by the slough and prevents or moderates the inflammation, and when the slough separates an eschar is to be formed over the exposed sore.

In the neglected and severer cases of bruise attended by much inflammation, it will be found best to treat the part for a day or two by a cold poultice to give time for the inflammation to subside; otherwise the caustic might induce vesication of the skin, as I have mentioned already, p. 5, and the eschar could not be adherent.

CASE XIV.

The first case of bruise which I shall detail was not severe, but will serve to ill.u.s.trate the mode of treatment by the adherent eschar.

Mr. Symons, aged 60, slipped off a chair and bruised the s.h.i.+n, last evening; the skin was removed to the extent of an inch in one part and a square inch in another. He applied a common poultice. During the night he had much pain, and to-day there is much inflammation round the wounds. I applied the lunar caustic over both wounds and covered the eschar with gold-beater's skin to prevent the contact of the stocking.

On the following day the eschar was found to be perfect. The pain had entirely ceased. There was a little vesication round one of the wounds. I simply evacuated the fluid of the vesication and left the part exposed to dry.

On the third day there was no pain or inflammation, and the eschar remained adherent.

From this time no remedy was required. The eschar separated leaving the surface healed, in about a month from the occurrence of the accident. The patient suffered no sort of inconvenience nor was he confined from his labours a single day.

CASE XV.

The following case was far more severe, but the mode of treatment was not less efficacious.

Mr. Granger, aged 36, was exposed to a severe bruise by a great weight of stones which had been piled up, falling upon the outside of the leg; he was extricated from this situation with much difficulty.

Besides the bruise, the skin was removed from the outside of the leg to the extent of ten or twelve inches in length, and in some parts an inch and half in breadth; and in the forepart of the ankle a deep furrow was made by the rough edge of one of the stones. I applied the caustic in about half an hour after the accident, over the whole surface of the wounds, and protected the eschar by the gold-beater's skin. The patient was directed to keep the leg cool and exposed to the air. He took no medicine.

On the succeeding day the leg was a little swelled, but the patient did not complain of any acute pain but only of a sense of stiffness.

An adherent and perfect eschar was found to be formed over the whole extent of the wound. There was no fever.

On the third day, the swelling had abated. No further remedy. The patient was still enjoined to rest.

On the fourth day the swelling was nearly gone. The eschar remained adherent. The patient walks about.

From this time the patient pursued his avocation of a stone-mason; no further remedy was required; no inconvenience experienced; and the eschar separated in about a month.

I think it totally impossible to have cured this wound, by any other remedy, in less than a month; during which period the patient must have suffered much pain and fever, and have been quite confined.

It is also quite certain, I think, that there would have been an extensive slough, from the severity of the bruise. This was doubtless prevented by the application of the caustic.

CASE XVI.

J. Jennings, bricklayer, aged 26, fell through the roof of a house and bruised and lacerated his s.h.i.+n rather severely to the extent of an inch and half in one part and in several other places in a less degree. I applied the lunar caustic to the wound immediately.

On the following day the eschar was found to be adherent, and there was neither pain nor swelling.

The eschars separated in nine days leaving the wounds healed.

It is remarkable that the eschar remains a greater or less time over the wound according to the severity and exigency of the case. This case being less severe than the former one the eschar remained upon the wound during a much shorter period of time.

CASE XVII.

An old man, aged 60, received a bruise upon the occiput from a fall; the skin was lacerated and removed to the extent of half-a-crown. I applied the lunar caustic soon after the accident.

On the next day an adherent eschar was formed. There was neither pain nor swelling.--The eschar separated in a fortnight.

CASE XVIII.

Mrs. C. aged 40, was detained on a journey by a bruised wound on her knee, received a fortnight before, which was healing very slowly under the usual mode of treatment. The inflammation was subsiding but the sore was extremely irritable and painful, and she was prevented from moving. From the degree of inflammation still present, I applied the lunar caustic very slightly over the sore and not over the inflamed skin; I left the eschar to dry, but was very doubtful, from the same cause, whether it would be adherent or no.

On the succeeding day I found that the eschar did remain adherent and that the inflammation was diminished, and the soreness had entirely subsided after that induced by the caustic had ceased.

On the next day, the lameness was gone, and there was no sort of inconvenience from the wound. My patient continued her journey on the following day, so that I do not know when the eschar separated.

In regard to the inflammation attendant on these wounds, I would remark that slight inflammation is relieved by the application of the lunar caustic and does not prevent the formation of an adherent eschar; but very severe inflammation requires the application of the cold poultice and lotion over the wound, and it is necessary to watch for the period when an eschar may be attempted with the lunar caustic.

This a little experience will readily teach.

It is further to be particularly observed that the inflammation attendant on a recent wound is removed by the caustic, when the same degree of inflammation at a later period, and with suppuration, would be aggravated and require the cold poultice and lotion, and render the formation of an adherent eschar impossible. This fact, the result of much experience, is extremely interesting, and, I think, not easy to be explained. It is ill.u.s.trated by the following case.

CASE XIX.

Robert Hill, aged 16, received a blow yesterday from a bone which was thrown at him, upon the outer condyle of the humerus. He complains of extreme pain and there are much redness and swelling. I applied the lunar caustic and directed the part to be exposed to the cold air.

On the succeeding day, I found that the eschar was quite adherent, and that the pain, redness and swelling had much subsided, although there was some stiffness of the elbow.

On the third day there was still further amendment. From this time no remedy or attention was required.

CASE XX.

It frequently occurs to surgeons to receive slight wounds upon the hands which prove very troublesome. Of this kind is the following.

Mr. L.C. had an irritable and inflamed sore on the ulnar side of the third finger, occasioned by a bruise a fortnight ago. Many applications had been made during this fortnight but the sore had no disposition to heal. I applied the lunar caustic to form an adherent eschar.