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Punctures Case Viii

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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