Categories: ON THE APPLICATION OF THESE MODES OF TREATMENT TO PARTICULAR CASES.
Sources: Application Of The Lunar
Caustic In The Cure Of Certain Wounds And Ulcers
From the preceding observations it would naturally be concluded that
the lunar caustic would afford a remedy for the treatment of ulcers.
This conclusion is perfectly just. Yet there are many circumstances
which render the mode of treating ulcers by the caustic, efficacious
or the contrary.
In order that the treatment by eschar may be successful, there must be
the following conditions in regard to the ulcer: first, the surface
occupied by the ulcer must not be too extensive; secondly, it must
not be exposed to much motion or friction; and thirdly, it must not be
attended by a profuse discharge; for all these circumstances have a
direct effect in, preventing the formation of an adherent eschar or of
removing it if formed.
I observe, therefore, that I have not found the mode of treatment by
eschar to succeed in large ulcers of the legs. But in small ulcers,
and especially in those irritable and painful little ulcers which are
so apt to form about the ankle and occasionally occur near, the tendo
achillis, and in which Mr. Baynton's plan is inadmissible, the caustic
is invaluable; in these cases the cold poultice and lotion should
precede the application of the caustic, for a few days, that the
irritability and inflammation of the sore and surrounding skin may be
first subdued; and after the eschar is formed, the part must be kept
exposed to the air and defended from external injury, by enjoining the
patient to wear trowsers and to be careful not to disturb the eschar.
The plan of curing ulcers is exactly what has been described in the
treatment by the unadherent eschar. For in these cases the eschar is
generally unadherent at first. It is necessary therefore in all cases,
except those of very small ulcers, to examine the eschar, making a
small puncture or rather smooth incision in its centre, so as to
evacuate the subjacent fluid if there be any, taking great care not to
break down or bruise the eschar so as to leave its inferior surface at
all ragged. This operation should be repeated daily until the eschar
proves to be quite adherent. And if the ulcer be rather large, rest
should be enjoined until the adherent eschar be fully and safely
formed, and a dose of saline purgative may be interposed. It must also
be particularly borne in mind, that the eschar must be constantly
defended by the gold-beater's skin, which must be removed and
reapplied at each examination.
I have here spoken of ulcers upon the legs. But the same observations
apply to ulcers on other parts of the body, and these are, in general,
far more manageable than the former, and do not require the same rest
during the unadherent state of the eschar.