An Essay on the Application of the Lunar Caustic in the Cure of Certain Wounds and Ulcers Part 6

In slight cases the lunar caustic may be pa.s.sed over the inflamed part, and in this manner suppuration and the continuance of inflammation is often prevented.

In those cases in which the suppuration is artificial and attended with severe diffused inflammation, the pus should be evacuated and a cold poultice applied for a day or two; for the too early application of the caustic would only add to this kind of inflammation; see p. 11; afterwards the skin may be removed, and if there be excoriations the caustic may be lightly applied.

2. _Of Inflammation of the Finger._

The following case of inflammation of the finger occurred without any a.s.signable cause.

CASE x.x.xI.

A young man, aged 18, came to me with a painful swelling of the middle finger of the right hand; suspecting deep-seated abscess, I made a free incision and evacuated a little pus. I then applied the lunar caustic within the cavity and directed a cold poultice to be applied with lotion.

On the fourth day my patient had returned to his occupation as a dyer.

CASE x.x.xII.

Miss B. aged 23, had a slight scratch on the inside of the index finger, which issued in severe inflammation extending over the back of the hand. I made a free incision in the part first affected, evacuated a little pus, and directed a poultice to be applied.

On the following day, there was less pain but still great swelling at the back of the hand, which, I think, would have been removed had the caustic been used.

I now applied the caustic freely within the orifice.

On the following day there was less swelling and discharge.

Two days afterwards, the caustic was again applied, and in eight days from the first application of the caustic the hand was quite well.

3. _Of Fungous Ulcer of the Navel in Infants._

It sometimes occurs that a little fungous sore exists upon the navel in infants which is difficult of cure in the ordinary way. I had one case which had subsisted for two years, and another, which had continued for two months, and were, during those periods, a source of great trouble and uneasiness to the mothers of the little patients.

These ulcers are easily cured in the following manner.

The fungus is to be completely removed by a pair of scissors, and when the bleeding has quite ceased, the lunar caustic is to be applied, and the part defended by the gold-beater's skin and kept carefully from any moisture.

In one of the cases mentioned above the eschar was accidentally separated twice and required to be renewed; but both cases were cured in the s.p.a.ce of a few days.

4. _Of Inflammation of the Knee._

Servant women, I suspect from much kneeling in scouring stairs, &c.

are subject to a species of inflammation of the knee which is frequently extremely troublesome.

In one case suppuration of the integuments took place in the forepart of the knee, and the patient was obliged to leave her situation and go to her friends at a distance, although every antiphlogistic means was tried for her relief.

In two other cases, after the application of twenty leeches and the administration of an emetic and purgative medicine, I applied the lunar caustic freely over the whole surface of the knee previously moistened with water. In a few hours the cuticle was raised and vesicated; I evacuated a viscid puriform fluid, and I directed the constant application of the cold poultice and lotion.

In a few days all inflammation subsided and the patients remained well.

These three cases having occurred to me at the same time, and being apparently equally severe, I was enabled to judge of the efficacy of this use of the caustic, and I can strongly recommend it to a future and further trial. Its application causes more pain than a blister, but not so much as to form an obstacle to its employment.

It may not be unimportant, here, to suggest the trial of the caustic in other cases of inflammation, in which a more than usually active local remedy is required.

5. _Of Tinea Capitis, &c._

In this place I have only to observe that I have in some cases completely succeeded, in others completely failed, in the cure of tinea capitis, by the lunar caustic. As I have not hitherto distinguished these cases from each other; and as I could only offer conjectures on the subject, I think it best to leave it for future inquiry.

The same observation applies to some other cutaneous affections which I need not specify more particularly at the present.

CHAPTER III.

OF SOME CASES IN WHICH THE CAUSTIC IS INAPPLICABLE.

It is by no means my intention to recommend the application of the lunar caustic as an infallible remedy for all local diseases. I am quite aware of the propensity, in recommending a favourite remedy, to extend its use beyond its true limits. The caustic, like all other remedies, requires to be employed with discrimination; and it is therefore my object in this little work, to state in which cases it is, and in which cases it is not, useful and successful.

With this object, I have thought it not improper to add, in a concluding chapter, some observations on those cases in which I have found the lunar caustic to be inadmissible. It will, at the same time, be found that such cases, in the course of their treatment by the ordinary measures, not unfrequently become fit cases for the application of the caustic, with the view of more speedily completing the cure.

This observation is particularly applicable to the cases of burns, of large ulcers, of fungous ulcers, &c.

The caustic is inapplicable in extensive lacerations, for the same reason that it is so in extensive ulcers.

I have found the caustic of little use in incised wounds, and should not employ it except in such wounds received in dissection.

I have failed in my attempts to heal scrofulous sores by the adherent eschar; I would propose the trial with the lunar caustic and poultice.

In erysipelatous inflammation, where vesicles are formed, the caustic does injury, as in recent burns.

I have always found that the caustic has done injury in boils, aggravating rather than diminis.h.i.+ng the affection.

1. _Of Burns._

The application of the lunar caustic in recent burns or scalds, has always appeared to me to increase the inflammation and vesication, even inducing blisters where there were none before. The caustic must not, therefore, be applied in these cases, until the inflammation has entirely subsided; but when there remains only a small superficial ulceration, the caustic may be pa.s.sed lightly over the ulcerated surface to form an eschar which is to be defended by the gold-beater's skin; for the affection is then reduced to the state of a common superficial ulcer. An adherent eschar is generally readily formed, and no further application is required. If the ulceration be more extensive and deeper, the lunar caustic may be applied, and the eschar treated, exactly as in common ulcers.

It may be well to ill.u.s.trate these points, by the following cases.

CASE x.x.xIII.

A little girl, aged 10, scalded her breast a week ago and has treated it with the ordinary remedies. There remained a superficial ulceration of the size of half-a-crown. I applied the lunar caustic lightly over the surface of the sore, and then the gold-beater's skin.

On the following day, an adherent eschar had formed, and in five days more it dropped off leaving the ulcer quite healed.