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Punctures Case ViiiCategory: ON THE APPLICATION OF THESE MODES OF TREATMENT TO PARTICULAR CASES. Source: Application Of The Lunar Caustic In The Cure Of Certain Wounds And Ulcers This case illustrates 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 pass 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 illustration 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 constitutional remedies being actively enforced. * * * * * In connexion with punctured wounds I here subjoin several cases of the bites of animals. Next: Punctures Case Ix Previous: Punctures Case Vii
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