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Burns Case Xxxv





Category: OF SOME CASES IN WHICH THE CAUSTIC IS INAPPLICABLE.
Source: Application Of The Lunar Caustic In The Cure Of Certain Wounds And Ulcers

The following case will present a specimen of my trials of the lunar
caustic in larger ulcers.

Anthony Knowles, aged 44, was kicked by a horse on the leg, above the
inner ankle, two years ago. The part has never healed, but still
remains in the state of an open ulcer, attended by some inflammation.
When I first saw this ulcer it was about two inches in diameter and
nearly circular, with high edges, a surface of a greenish colour, and
without any healthy granulations. I applied the lunar caustic to form
an eschar.

The pain from the caustic was severe for several hours. An eschar had
formed round the edges, but in the middle part it was quite wanting;
the inflammation surrounding the ulcer had abated, and the green hue
of its surface had disappeared. I reapplied the caustic in the central
part.

On the following day the eschar appeared tolerably complete in the
centre but had separated at one part of the circumference. I again
applied the caustic to the defective part.

On the following day the eschar was defective in several parts, but
the inflammation was quite removed, there was no pain, and there had
been less smarting after each successive application of the caustic. I
again applied the caustic.

On the succeeding day, I learnt that my patient had been intoxicated,
and I found the ulcer attended by inflammation. The eschar was by no
means complete; some part of it was in a detached state. I removed
the loose portions and repeated the application of the caustic.

This sort of treatment was continued for a fortnight without my being
able to effect the formation of a complete eschar. I therefore
relinquished the idea of healing the ulcer by the adherent eschar; I
eventually succeeded in doing so by applying the caustic every third
day and the poultice continually, and I had hopes that the cure might
be permanent, but he made application to me in two years afterwards
with a similar ulcer on the same part.

In another similar case, I removed the elevated hard edges of the
ulcer by the lancet, and then tried the caustic, without better
success.





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